Co-creating menstrual health interventions with university students in Ecuador: findings from a participatory pilot study

IntroductionPoor menstrual health negatively impacts psychosocial and physical health, and subsequently leads to poor school outcomes, but the effort to improve adolescent girls’ menstrual health in Tanzania remains fragmented. This...

ObjectivesFew studies have assessed sleep among African adolescents. We aim to understand factors associated with subjective sleep quality among female Ugandan adolescents and the association of poor sleep quality with subsequent menstrual- and mental health, and educational performance.MethodsWe analyzed data from a cluster-randomized controlled trial that evaluated a menstrual health intervention in 60 Ugandan secondary schools. Data were collected through cross-sectional surveys at baseline (March-June 2022) and endline (July-August 2023), and prospective daily diaries (April-August 2023). We used logistic regression to analyze associations with poor sleep at baseline, and linear regression to analyze associations of poor sleep with subsequent menstrual and mental health, and education performance, adjusting for clustering.ResultsOf 3841 female participants (mean age = 15.6 years), 580 (15.1%) reported poor sleep quality and 829 (21.6%) reported feeling tired at baseline. Poor sleep was associated with socio-economic factors including smaller household size, lower socioeconomic status, and fewer meals consumed the previous day. There was strong evidence that poor sleep at baseline was associated with multiple dimensions of poor menstrual health including menstrual pain (adjusted odds ratio = 1.74, 95%CI 1.29-2.33), more unmet menstrual practice needs (adjusted odds ratio = 2.68, 95%CI 1.99-3.60), and with mental health problems (adjusted odds ratio=2.40, 95%CI 1.80-3.19). Results were similar for baseline tiredness. Prospectively reported poor sleep quality was associated with subsequent poor menstrual and mental health, and subsequent poor educational performance.ConclusionsPoor sleep is prevalent among in-school female Ugandan adolescents and is associated with subsequent poorer menstrual health, mental health, and educational performance. Improving sleep in this population could benefit menstrual health, mental health and education outcomes.

Negative menstruation experiences adversely affect schoolgirls' social participation, education, and overall health, yet comprehensive menstrual health interventions are limited in Tanzanian schools. This study evaluated the feasibility, acceptability, cost, and potential impact mechanisms of a comprehensive school-based menstrual, sexual, and reproductive health (MSRH) intervention. The intervention, piloted in four secondary schools, included education sessions for girls and boys, pain management, distribution of menstrual kits (reusable pads and menstrual cups), WASH improvements, and stakeholder engagement. A mixed-methods process evaluation assessed acceptability, fidelity, cost, context, and potential impact mechanisms using qualitative methods (in-depth interviews, focus group discussions, and WASH observations) and quantitative methods (survey questionnaires, structured observation of education sessions, costing, and monitoring data). The intervention was well received by students, teachers, and local government authorities; MSRH education reached 86% of schoolgirls and 72% of schoolboys, while over 93% of girls received menstrual kits. Total implementation cost across the four schools was 111,347,467 TZS (38,003 GBP), approximately 39.05 GBP per student, lower than comparable initiatives in East Africa. Findings indicate the intervention is feasible and acceptable in school settings and can inform future menstrual health and hygiene programs, though further research is needed to assess broader effectiveness and sustainability.

The development of soft skills in academic and professional environments is crucial for the success of professionals in the fields of science, technology, engineering, and mathematics, known as STEM. Especially in engineering, soft skill development reflects the growth and progress of a country. Therefore, higher education institutions should focus not only on the development of soft skills but also on the acquisition of specific technical competencies in engineering. It should also be considered that the development of soft skills is self-perceived and progresses differently in men and women. A positive self-perception of leadership and communication skills significantly influences women's decision to start or continue a STEM career, which may contribute, among other factors, to reducing the gender gap in civil engineering careers-one of the main global issues. Therefore, the main objective of this study is to conduct a comparative analysis of the self-perception of leadership and communication skills among high school and university students in southern Ecuador to design attraction campaigns that encourage interest in STEM careers. The study was conducted with high school students from a public school in the Catamayo canton and civil engineering students from Loja, Ecuador. To gather information, a structured 12-question survey was applied to 68 high school and university students. The results reveal greater variability in the responses of high school students and greater stability in the responses of university students. Regarding communication skills, both high school and university students perceive themselves positively, with women showing greater consistency at the university level compared to men. In terms of leadership, women show a decrease in their selfperception of leadership from high school to university, unlike men. The project's results are limited to a specific group of students; however, they motivate further research with samples from diverse geographical locations to generalize the findings.

Menstrual health is critical to achieving gender equity and reaching the 2030 Sustainable Development Goals, yet evidence on the health impacts of menstrual products-particularly on the vaginal microbiota-is limited. The Improving Menstrual and Vaginal Health for All (IMVAHA) project aims to address this knowledge gap through qualitative exploration, a health survey and clinical trial embedded in three sister projects: Laura (Peru), Leke (Cameroon) and Marie (Switzerland). This paper outlines the protocol for the IMVAHA health survey and clinical trial studies, which aim to (1) assess menstrual hygiene practices, product preferences and vaginal health; and (2) evaluate longitudinal changes in vaginal microbiota associated with the use of pads, tampons and menstrual cups. The IMVAHA project will take place in urban Cameroon, urban Peru, and in Switzerland. The baseline survey will explore vaginal and menstrual health behaviours and preferences, including vaginal complaints, menstrual products and menstrual stigma. Descriptive statistics will be calculated for a cross-sectional profile of vaginal and menstrual health within and between contexts, and mixed effects linear regression models will be run to identify associations between contextual factors and key vaginal and menstrual outcomes. From survey participants, 300 eligible, consenting women (100 per country) will be enrolled in a 7-month crossover clinical trial. As a self-controlled trial, a dedicated control group is not necessary. Each participant will use pads, tampons and menstrual cups for two menstrual cycles per product, providing vaginal swabs at baseline and post-menstruation. Swabs will undergo 16S rRNA sequencing, pH testing and screening for toxic shock syndrome-related bacteria. A short survey on health behaviours and symptoms, menstrual hygiene practices and participant experiences with different menstrual products will be administered during each menstrual period. The primary outcome of the clinical trial is the log ratio of Dialister to Lactobacillus crispatus abundance measured after the use of different menstrual products. Mixed-effects linear regression will assess differences in the primary outcome across product types. Secondary analyses will include per-protocol comparisons and ORs with 95% CIs. The study complies with the Declaration of Helsinki, Council for the International Organizations of Medical Sciences guidelines and local regulations. Ethical approval has been obtained in all three countries (National Ethics Committee for Human Health Research in Cameroon (CE N° 2024/03/1649/CE/CNERSH/SP); the Institutional Review Board of the Universidad Peruana Cayetano Heredia and Universidad Nacional de la Amazonía Peruana in Peru (217572) and the Ethics Commission of Northwest and Central Switzerland (2024-02135)). Informed consent will be obtained from all participants after detailed explanation of study procedures and risks. Data will be securely stored, with participant anonymity maintained. A political economy analysis will explore regulatory environments for menstrual products, and findings will be disseminated through policy briefs, stakeholder networks, academic publications and conferences. NCT06646185.

ABSTRACTObjectiveTo evaluate the prevalence and determinants of analgesic self‐medication among university students in Ecuador, with a focus on the interplay between pharmacological knowledge and personal attitudes.MethodsA cross‐sectional analytical study was conducted with 422 students at Universidad Tecnologica Indoamerica (April–August 2025), selected via stratified random sampling. A validated, structured questionnaire assessed knowledge, attitudes, and practices. Multivariable logistic regression and random forest algorithms were employed to identify key predictors and their relative importance.ResultsThe prevalence of analgesic self‐medication was exceptionally high at 87.5%. Random forest analysis identified attitude as the primary predictor of this behavior (relative importance = 0.252), followed by academic year and pharmacological knowledge. A significant “knowledge–attitude paradox” was observed, wherein health sciences students, despite possessing superior pharmacological knowledge, exhibited the highest rates of self‐medication. The predictive model demonstrated excellent discrimination (AUC = 0.81).ConclusionThe high prevalence of self‐medication, a finding consistent with emerging international data, necessitates a fundamental paradigm shift in public health interventions. Educational strategies must evolve beyond simple information dissemination to incorporate behavioral science principles aimed at modifying attitudes and risk perceptions, particularly during the formative early years of university education.

BackgroundAchieving good menstrual health (MH), integral to women’s well-being, remains a challenge. This study examined MH services uptake (including information, analgesics, and a choice of MH products - the menstrual cup and reusable pads) and sustained use of MH products within an integrated sexual and reproductive health intervention for young people in Zimbabwe.MethodsThis study was embedded within a cluster randomised trial of integrated sexual and reproductive health services (CHIEDZA) in three provinces (Harare, Mashonaland East, and Bulawayo). The study collected qualitative and quantitative data from female clients aged 16–24 years, who accessed CHIEDZA from April 2019 – March 2022. Uptake of MH information, products, and analgesics and other services was tracked for each client. Descriptive statistics and logistic regression were used to investigate MH service uptake and product choice and use over time, and the factors associated with these outcomes. Thematic analysis of focus group discussions and interviews were used to further explore providers’ and participants’ experiences of the MH service and CHIEDZA intervention.ResultsOverall, 36991 clients accessed CHIEDZA of whom 27725 (75%) were female. Almost all (n = 26448; 95.4%) took up the MH service at least once: 25433 took up an MH product with the majority (23346; 92.8%) choosing reusable pads. The uptake of cups varied across province with Bulawayo province having the highest uptake (13.4%). Clients aged 20–24 years old were more likely to choose cups than reusable pads compared with those aged 16–19 years (9.4% vs 6.0%; p < 0.001). Over the implementation period, 300/1819 (16.5%) of clients swapped from the menstrual cup to reusable pads and 83/23346 (0.4%) swapped from reusable pads to the menstrual cup. Provision of the MH service encouraged uptake of other important SRH services. Qualitative findings highlighted the provision of free integrated SRH and MH services that included a choice of MH products and analgesics in a youth-friendly environment were key to high uptake and overall female engagement with SRH services.ConclusionsHigh uptake demonstrates how the MH service provided much needed access to MH products and information. Integration of MH within an SRH intervention proved central to young women accessing other SRH services.

BackgroundDespite being integral to women’s well-being, achieving good menstrual health (MH) remains a challenge. This study examined MH services uptake (including information, analgesics, and a choice of MH products - the menstrual cup and reusable pads) and sustained use of MH products within an integrated sexual and reproductive health intervention for young people in Zimbabwe.MethodsThis mixed-methods study was nested within a cluster randomised trial of integrated sexual and reproductive health services (CHIEDZA) for youth in three provinces (Harare, Mashonaland East, and Bulawayo). The study collected qualitative and quantitative data from 27,725 female clients aged 16–24 years, who accessed CHIEDZA from April 2019 – March 2022. Using a biometric (fingerprint recognition) identification system, known as SIMPRINTS, uptake of MH information, products, and analgesics and other services was tracked for each client. Descriptive statistics and logistic regression were used to investigate MH service uptake and product choice and use over time, and the factors associated with these outcomes. Thematic analysis of focus group discussions and interviews were used to further explore providers’ and participants’ experiences of the MH service and CHIEDZA intervention.ResultsOverall, 36,991 clients accessed CHIEDZA of whom 27,725 (75%) were female. Almost all (n = 26,448; 95.4%) took up the MH service at least once: 25433 took up an MH product with the majority (23,346; 92.8%) choosing reusable pads. The uptake of cups varied across province with Bulawayo province having the highest uptake (13.4%). Clients aged 20–24 years old were more likely to choose cups than reusable pads compared with those aged 16–19 years (9.4% vs 6.0%; p < 0.001). Over the implementation period, 300/1819 (16.5%) of clients swapped from the menstrual cup to reusable pads and 83/23346 (0.4%) swapped from reusable pads to the menstrual cup. Provision of the MH service encouraged uptake of other important SRH services. Qualitative findings highlighted the provision of free integrated SRH and MH services that included a choice of MH products and analgesics in a youth-friendly environment were key to high uptake and overall female engagement with SRH services.ConclusionsHigh uptake demonstrates how the MH service provided much needed access to MH products and information. Integration of MH within an SRH intervention proved central to young women accessing other SRH services.

For women, menstrual hygiene is an essential component of overall health. Achieving menstrual health means giving women and girls the resources and support they need to confidently take care of their bodies. The challenges of menstrual health are exacerbated due to period poverty and it is a problem with long-standing worldwide implications for community health. Period poverty is characterized by limited access to sanitary facilities, education, and menstruation supplies. The present study focuses on the unique challenges that university students encounter concerning menstrual health, particularly in the context of financial constraints. This research aims to shed light on the intersection of period poverty, academic life, and the ability to manage menstrual health challenges effectively. Different experiences of menstrual challenges faced by female university students due to financial constraints could be broadly grouped into four main themes including financial struggles, product choice and cultural sensitivities, physical and psychological challenges, and adapting to financial constraints. Many important economic and social problems are brought about by the rising cost of personal hygiene products and the ensuing impact on the financial standing of female college students. In order to enhance menstrual health, it is also imperative to address societal taboos surrounding certain hygiene items. Our findings show how important it is to acknowledge and address the financial aspects of menstruation health, increase awareness of less expensive options, and advocate for freely available and economically feasible menstrual hygiene products for female university students.

Introduction Immigrant populations continue to face challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). A key component of bodily autonomy and sexual health knowledge and access is menstrual equity. Menstrual equity is recognized as access to affordable and safe menstrual products, to sanitary and stigma-free spaces to manage cycles, and menstruation education. Limited data exists on menstrual experiences of South and Southeast Asian communities-culturally and religiously distinct groups—in the US, raising concerns for ongoing, understudied barriers impeding menstrual equity in the immigrant diaspora. Additionally, there is limited research on South Asian immigrant access to sexual health clinics in the United States; understanding the barriers to menstrual equity in this population will highlight future pathways to improve sexual health access. Objective 1. To identify specific generational, cultural, and religious barriers to accessing menstrual supplies, knowledge, and clinical care in the South Asian and Southeast Asian immigrant population 2. To explore how menstrual inequities impact sexual health and bodily autonomy in this population. Methods This IRB approved qualitative study (IRB 24-1129) involved Zoom-based interviews for thematic analysis on topics of reproductive justice in the United States within the South Asian and Southeast Asian communities. Purposeful sampling technique was utilized. Inclusion criteria include age 18 years or older, self-identification as South Asian or Southeast Asian, current US residency, English-speaking, and having a uterus and menstrual cycles. Rapid and rigorous qualitative analysis was used to identify codes and themes. Descriptive statistics were used to categorize demographics data. Results Respondents (n = 11), 91% (n = 10) self-identify as South Asian. A majority use pads for managing their cycles (n = 9). One third of the respondents reported feeling embarrassed by their periods initially, and nearly half report self-advocating for supplies and menstrual management upon entering college. Many respondents report trepidation using hormone treatments for menstrual management, with concerns of negatively impacting their long-term sexual and menstrual health based on their parents’ concerns. About one-third report increased comfort with a race-concordant and gender-concordant gynecologist, with several noting cultural and generational biases against discussing sexual health within families and with gynecologists. About one third of respondents reported experiences of bias and racism with their gynecologists. Nearly 66% of respondents struggled silently with menstrual health and sexual health pathologies during adolescence without clinical treatment. Conclusions This pilot study highlights the need for additional resources and attention on the needs of immigrants in the United States, particularly from the South and Southeast Asian communities, when it comes to menstrual equity and associated sexual healthcare access. Cultural and religious barriers include generational misinformation, menstrual silence, fear of hormonal contraception, and discomfort with non-gender concordant gynecologists. Additionally, patient misinformation on sexual health prevented desired discussions on individual menstrual and sexual health needs in clinical settings. Addressing cultural barriers is paramount to ensuring equitable access to sexual health medicine and knowledge for all immigrant communities. Future directions include increased community and clinical engagement around menstrual and sexual health needs and support for these unique and understudied populations. Disclosure No.

Anemia is a significant public health concern, particularly among young female adults due to its potential impact on reproductive health. This study investigated the association between anemia-related knowledge, attitudes, menstrual health, and anemia status among Malaysian university students. This was a cross-sectional study named “SCARF” - Study to Combat Anemia - Research for Female Students, involving 674 university students in Malaysia. Anemia status was determined based on haemoglobin level, while knowledge, attitude and menstrual health were measured using validated questionnaires. The mean menarche age of students in this study was 12.1 ± 1.21 years. Students who were anemic had significantly longer menstrual cycle duration (P = 0.034) and more days with heavy flow (P = 0.038). Most students had poor knowledge (44.5%) and attitudes (84.1%) towards anemia. Students with good knowledge were 1.1 times more likely to have better anemia status compared to those with poor knowledge (95% CI: 1.0–1.2, P = 0.049). This study highlighted a lack of practical application of the knowledge to dietary habits. Collaborative efforts between educators and healthcare providers are crucial in developing a comprehensive strategy, such as interventions to prioritise educational initiatives and practical support to enhance overall menstrual health among female students.

BackgroundMenstrual health is closely linked to mental health, especially depression and anxiety. However, their relationship remains understudied. This study analysed the association between menstrual health and self-reported depression and anxiety in women and people who menstruate (PWM) (aged 18 year or over) in Spain.MethodsA gender-based cross-sectional study was conducted in 5 regions in Spain. Participants were women and PWM aged 18 or over with at least one menstruation in the last 6 months. Data were collected through an online survey in 32 healthcare centres in 2023. Outcome measures were self-reported depression and anxiety and menstrual health variables (e.g., menstrual pain intensity, menstrual poverty). Descriptive statistics and ordinal logistic regression models were performed.ResultsAmong participants (N = 1,404), the odds of depression and anxiety were associated with some menstrual health variables. For instance, a higher menstrual pain intensity increased the odds of depression (aOR= 2.10, 95%CI, 1.58-2.79) and anxiety (aOR= 1.84, 95%CI, 1.39-2.44). This same tendency was identified for the frequency of premenstrual symptoms (aORdepression= 13.59, 95%CI, 9.62-19.19; aORanxiety= 12.34, 95%CI, 8.72-17.48), menstrual taboo, stigma and discrimination (aORdepression= 2.14, 95%CI, 1.65-2.78; aORanxiety= 2.27, 95%CI, 1.75-2.96), menstrual poverty (aORdepression= 2.31, 95%CI, 1.53-3.50; aORanxiety= 2.43, 95%CI, 1.62-3.65), and social participation impairments due to menstruation (aORdepression= 6.84, 95%CI, 4.64-10.07; aORanxiety= 6.45, 95%CI, 4.36-9.53). Some sociodemographic characteristics mediated the relationship between menstrual health variables and anxiety and depression.ConclusionsPoorer menstrual health outcomes were associated with higher levels of depression and anxiety. This empathises the need to address both the relationship of menstrual health, depression, and anxiety in future public health interventions, policies and legislation.Key messages• Higher levels of depression and anxiety are associated with poorer menstrual health outcomes.• Sociodemographic factors influence how menstrual health is associated to depression and anxiety.

Introduction Despite the rising profile of women’s health, menstrual health remains under-researched and under-integrated in community pharmacy sexual and reproductive health (SRH) services in the UK [1]. Menstruation affects over 800 million individuals globally at any one time [2], yet limited UK-based literature explores community pharmacy-led interventions in this area. This study aimed to explore the physical, emotional, and knowledge-based dimensions of menstrual health among young women and assess the potential role of community pharmacy in providing accessible, non-judgmental menstrual health support. Aim To identify perceived benefits and barriers to integrating menstrual health into UK community pharmacy SRH services, and to explore the menstrual health experiences of final-year female pharmacy students. Methodology A qualitative study was conducted with ten final-year female MPharm students at the University of Birmingham, recruited using purposeful snowball sampling [3] via social media. Participants completed an anonymous demographic survey followed by a ninety-minute, in-person focus group. The discussion was recorded, transcribed verbatim, and thematically analysed using Braun and Clarke’s six-step framework [4] to produce six key themes from initial codes. Ethical approval was granted by the University of Birmingham School of Pharmacy Safety and Ethics Subcommittee (MP2425 012R1). Written and verbal informed consent was obtained from all participants. Results Survey responses indicated that 90% of participants experienced menstrual symptoms that significantly impacted their daily lives. Six key themes were identified: 1) reliance on other women for information rather than healthcare professionals, 2) cultural and social stigma surrounding menstruation, 3) lack of formal education in pharmacy curricula and among male professionals, 4) perceived inaccessibility and underutilisation of community pharmacy services for menstrual health, 5) normalisation and underreporting of symptoms, and 6) the influence of diet, stress, and exercise on menstrual wellbeing. Participants viewed community pharmacists as well-positioned to provide accessible, local, and trusted menstrual health services, particularly through integration into existing SRH frameworks such as Umbrella [5]. However, concerns were raised regarding funding, pharmacy professional training, gender-related barriers, and public awareness. Discussion The findings reveal a significant knowledge gap and unmet need in menstrual health education, access, and support for young women in the UK. Community pharmacies were recognised as potential providers of holistic, culturally sensitive menstrual health services. Integrating menstrual health into SRH services could reduce stigma, facilitate earlier intervention, and alleviate pressure on GPs. Expanding undergraduate pharmacy education and subsidised training for pharmacists may enhance confidence and service delivery. Study limitations include the small, homogenous sample and focus on healthcare students. Further research is required to explore broader public perspectives and pilot menstrual health interventions in community pharmacy settings.

ObjectivesWhile integral to women’s physical and mental well-being, achieving good menstrual health (MH) remains a challenge for many women. This study investigated the effectiveness of a comprehensive MH intervention on...

The purpose of this study was to establish the validity of the 7-item Generalized Anxiety Disorder scale (GAD-7) among university students in Ecuador. This study employed instrumental methodology, drawing on Classical Test Theory (CTT) and Item Response Theory (IRT). The sample consisted of 623 college students aged 18 to 38 (M = 20; SD = 2.4), of whom 59.6% were women and 39.4% were men. These students came from three universities in Ambato (Ecuador), with the majority (86.9%) attending private institutions. As results, it was confirmed that the GAD-7 has a unidimensional structure, high internal consistency, and convergent validity with a measure of pathological worry. Additionally, the scale demonstrated measurement equivalence across sex and the items exhibited appropriate discrimination and difficulty parameters. Finally, the GAD-7 is a valid and reliable instrument for assessing anxiety among university students in Ecuador.