To investigate the ovarian response in different phases of the menstrual cycle in breast cancer women candidates for fertility preservation. A retrospective study was carried out, including women with breast cancer undergoing oocyte cryopreservation at the Fertility Preservation Unit of the University of Naples Federico II between 2017 and 2023. Women who started ovarian stimulation during the follicular phase (FP) were compared with those who started during the luteal phase (LP). The two study groups were further stratified according to the phase of the menstrual cycle at ovarian stimulation initiation: early (day 1-5, EFP) or late follicular phase (day 6-14, LFP), early (day 15-21, ELP) or late luteal phase (day 22-32, LLP). The primary outcome was oocyte recovery. A total of 113 women who underwent fertility preservation for breast cancer were included. No differences in oocytes retrieved and ovarian sensitivity were observed when comparing follicular and luteal phases. No differences were observed regarding oocytes retrieved and ovarian sensitivity among the four groups divided according to the menstrual cycle phase. Ovarian stimulation was significantly shorter in the early follicular phase (9 days; 8-10) than in the other menstrual phases (LFP: 10 days, 9-11, p <0.04; ELP: 11, 9-11, p <0.004 and LLP: 11 days, 10-12, p <0.001). Our study's limitations are its small sample size and retrospective design. The phases of the menstrual cycle at which OS was started did not affect oocyte yield and ovarian sensitivity in women with breast cancer undergoing a random start protocol with letrozole.

To evaluate the experiences with an atraumatic device (Carevix®) for intrauterine device (IUD) placement in routine clinical practice. Our prospective, post-marketing study was conducted in 19 centers in Europe, Brazil and the USA. IUD insertions using Carevix device were documented for completion rates, patient-reported pain scores, cervical bleeding, and operator and patient satisfaction. Demographics, uterine position, and menstrual cycle phase were also recorded. A total of 1123 IUD placements were analyzed. Most participants (819/992; 83%) were 18-40 years old; 46% (513/1123) were nulliparous and 47% (526/1123) were menstruating at the time of the procedure. The procedure was completed with Carevix alone in 82% (925/1123) of participants. Additional tenaculum use was mostly due to spontaneous vacuum loss (194/1123). Completion rates without a tenaculum were lower in nulliparous than in parous women (78% versus 86%). Average visual analog pain scores were lower with Carevix alone (35 ± 21) than when a tenaculum was required (43 ± 21). Most participants (73%) reported less pain than expected, and only 3% reported more pain. Among providers, 82% were satisfied with Carevix, citing ease of use, visibility, and low patient discomfort. In a multicenter real-world setting, the novel, atraumatic device demonstrated feasibility and safety, with high completion rates and high satisfaction among both operators and patients.

Parents of autistic daughters may be able to provide insight into how to address menstruation and menstrual hygiene management from their lived experiences. Menstrual hygiene management is considered an activity of daily living that is within the scope of occupational therapy practice. To investigate the perspectives of parents of autistic daughters and their firsthand experiences of menstruation and menstrual hygiene management. This was a qualitative, phenomenological study that used convenience and snowball sampling and an inductive thematic analysis of transcripts of virtual semistructured interviews. Trustworthiness was established through audit trails, member checking, and the use of an interview guide. Interviews were conducted through Zoom at the participants' preferred time and location. Parents of autistic daughters (N = 8): seven biological mothers and one adoptive father. Seven themes emerged from the interviews: (1) inadequate expertise in women's health for autistic individuals among medical professionals, (2) parental dependency, (3) intensified sensory experiences before and during menstruation, (4) limited menstrual awareness and understanding in individuals with ASD, (5) menstrual product preferences, (6) parental feelings about managing menstruation, and (7) strategies that worked for managing menstruation. The findings suggest that parents face significant challenges when caring for autistic daughters during their menstrual cycles. Occupational therapy practitioners may support autistic individuals as well as their parents and caregivers in this process by having a deeper understanding of their experiences. Plain-Language Summary: This study sheds light on the perspectives of parents of autistic daughters on the topic of menstruation and menstrual hygiene management, which are considered activities of daily living. Occupational therapy practitioners may gain knowledge from these firsthand perspectives to inform future occupational therapy practice. Menstruation and menstrual hygiene management are important activities of daily living that are not addressed well for individuals living with autism. Occupational therapy practitioners can support autistic individuals and their caregivers in improving the participation and performance in menstruation and menstrual hygiene management.

To determine the extent to which abnormal uterine bleeding affects the quality of life in adolescents. The study included a total of 69 patients who presented to our clinic with menstrual bleeding lasting more than 7 days, occurring more frequently than every 21 days, and showing signs of increased blood loss within a cycle. Following the collection of detailed medical histories and physical examinations, initial diagnostic tests were performed, including a complete blood count, coagulation tests (prothrombin time, activated partial thromboplastin time, and fibrinogen), and iron parameters (serum iron, ferritin, and total iron-binding capacity). After obtaining informed consent, adolescents who presented to general pediatrics, pediatric endocrinology, and pediatric hematology clinics with complaints of abnormal uterine bleeding were asked to complete the Adolescent Menstrual Bleeding Questionnaire. The mean age of the 69 patients included in the study was 14.95 years (range: 11-18), and the mean age at menarche was 12.2 years (range: 9-16). Of the patients, 28.9% (n=20) had been admitted to the hospital for the first time due to bleeding, and 71.1% (n=49) had been admitted before and had used some treatments. During menstruation, 23.2% (n=16) of the patients reported severe pain, 43.5% (n=30) reported moderate pain, and 18.8% (n=13) reported mild pain. School absenteeism was observed in 36.2% (n=25) of the patients. Additionally, 63.8% (n=44) of the patients reported avoiding at least 1 day of family-related activities (such as household chores or shopping). The mean questionnaire score for patients with heavy bleeding was 33.9±1.6, while those with light to moderate bleeding had a mean score of 27±1.8 (p=0.005). As a result, 47.8% (n=33) of the patients scored below 30, and 52.2% (n=36) scored above 30. When patients scoring above and below 30 were compared, the need for adult diaper use, incidence of bleeding through outer clothing, school absenteeism, and level of activity avoidance were significantly higher in those scoring above 30. The highest score was observed in patients who had never received treatment [35.5 (±11.6) (11-61)] and the lowest score was observed in patients receiving iron and combined oral contraceptive pills (OCPs) treatment [28.6 (±10.06) (10-44)] (p=0.058) Anxiety levels were rated at 10 points by 36.2% (n=25) of the patients. The mean anxiety score of patients with an aMBQ score >30 was 8.64±2, and that of those with an aMBQ score <30 was 5.55±3.36 (p=0.000). The mean hemoglobin level of the patients was 12.4g/dL (range: 5.7-16). Fibrinogen, PT, and aPTT levels were within normal ranges. Abnormal uterine bleeding is not merely a physical issue but a public health concern that profoundly impacts the social and emotional lives of adolescent girls. A comprehensive approach is key to improving adolescents' quality of life.

Moderating and mediating effects of dysmenorrhea pain severity in the relationship between body mass index and body appreciation among adult women with primary dysmenorrhea.

Modulating metabolism and reproductive health through microbiome driven gut-brain axis therapies.

Relative Energy Deficiency in Sports (REDs) is defined as a multifactorial syndrome of impaired physiological and/or psychological functioning was previously named as the Female Athlete Triad. REDs was proposed to be an expansion of the Female Athlete Triad model (Triad), corresponding to a combination of Low Energy Availability (LEA), alteration of the menstrual cycle and bone health. could be made possible by a screening tool to determine the risk of LEA. The Low Energy Availability in Female-Questionnaire (LEAF-Q) is a screening tool originally developed to identify individuals at risk of Triad based on self-reported symptoms in three primary categories: injuries, gastrointestinal function, and reproductive function - to identify individuals at risk of Triad. To date, LEAF-Q is recommended in the International Olympic Committee REDs Clinical Assessment Tool-Version 2 as a screening tool for studying various health and performance outcomes of REDs. This study aims to validate the Italian version (LEAFQ-ITA) among physically active women while adapting it to their culture in order to enhance the diagnosis and facilitate access to treatment of REDs. The validation process was carried out in multiple stages: (i) translation and cultural adaptation of the content from the original questionnaire (LEAF-Q) into the Italian culture; (ii) expert validation of the content using the Delphi technique; (iii) reliability test-retest in a sample of Italian physical active women; and (iv) internal consistency checking using exploratory and confirmatory factorial analysis. A consensus rate of more than 90% for every item was considered sufficient agreement. The test-retest reliability was evaluated using the intraclass correlation coefficient estimates and their 95% confidence intervals based on a mean-rating, absolute agreement, 2-way mixed-effects model. Exploratory and confirmatory factorial analyses were performed with the Factor software. The analysis was implemented using a matrix dispersion through Pearson correlations and the Robust Diagonally Weighted Least Squares (RDWLS) extraction method. The Parallel Analysis technique suggested the number of factors to be retained. McDonald's Omega and Cronbach's alpha were performed to test internal consistency. After two rounds, the LEAFQ-ITA maintained the same amount of items and gained the consensus of content validation specialists. From the sample of 215 questionnaires answered, a sub-sample of 105 participants answered the LEAFQ-ITA twice (mean age: 26.1 ± 4.7 years old; mean body mass index: 21.3 ± 2.6 kg/m2; physical activity of 3.9 ± 1.3 days/week on average). Among them, 56 women (37.6%) obtained a were classified at risk of LEA by the final score of LEAFQ-ITA ≥8. The single measurement intraclass correlation coefficient resulted in 0.832 (F = 10.849, df = 105, p < 0.000, 95% confidence interval: 0.762-0.882), which suggests high reliability. Although initially hypothesizing the presence of 3 factors, the parallel analysis suggested 2 factors as being the most representative of the data. Measures of McDonald's Omega (0.65) and Cronbach's alpha (0.64) suggested acceptable internal consistency. The LEAFQ-ITA is a valid instrument for identifying Italian physically active women with physiological symptoms possibly related to LEA or REDs. Future research should focus on validating this instrument in other countries and languages.

Real-world validation of a bleeding prediction algorithm in levonorgestrel intrauterine device users using the MyIUS mobile app.

Heat stress and human reproduction: effects and pathogenesis.

BNT162b2 mRNA COVID-19 vaccine effectiveness in pregnancy: Emulating trial NCT04754594 using observational data from Norwegian health registries.

(1) Background: Transvaginal RFA is a minimally invasive treatment for myomas in women opting for uterus preservation. The present study aimed to evaluate the efficacy and safety of transvaginal RFA to treat myomas, reduce symptoms, decrease myoma volume, and identify prognostic factors for predicting treatment response. (2) Methods: The study group included 45 women treated for uterine fibroids at the Gynecological and Obstetrics Clinical Hospital in Poznań. From 1 July 2024 to 31 March 2025, a total of 45 transvaginal radiofrequency ablation (TV-RFA) procedures were performed. (3) Results: Ultrasound findings revealed that fibroid dimensions and volume significantly decreased at 1-month follow-up compared to those at pre-procedure (88.7 ± 116.3 vs. 64.6 ± 82.6 cm3; p = 0.003). Ultrasound findings demonstrated that fibroid depth (4.8 ± 2.1 vs. 4.1 ± 2.2; p = 0.01) and fibroid volume (88.7 ± 116.3 vs. 82.4 ± 93.9 cm3; p = 0.02) were significantly decreased at 3-month follow-up compared to their pre-procedure values. Menstrual bleeding duration showed significant differences between the pre-procedure state and 1-month follow-up (N = 23; T = 2; Z = 4.14; p &lt; 0.001) and 3-month follow-up (N = 8; T = 1; Z = 2.38; p = 0.017), with a significant reduction after the RFA procedure. Significant differences were observed in bleeding severity at pre-procedure and at 1-month follow-up (N = 22; T = 11.5; Z = 3.73; p &lt; 0.001); however, no significant differences in bleeding severity were noted at the 3-month follow-up (N = 7; T = 4; Z = 1.69; p = 0.09). These results should be interpreted cautiously due to the small number of patients with complete 3-month follow-up. (4) Conclusions: Transvaginal radiofrequency ablation is an effective, precise, and safe minimally invasive approach for treating uterine fibroids. These preliminary findings are promising but require confirmation in larger cohorts with longer follow-up.

Knowledge of fertile period among adolescent girls and young women (AGYW; 15-24 years) is crucial for understanding and managing reproductive health, yet it remains under explored. Many AGYW possess limited knowledge about their reproductive systems and the menstrual cycle, which can lead to misconceptions regarding fertile period and contraceptive use. In regions like Tanzania, where early and unintended pregnancies are prevalent, enhancing fertile period awareness through tailored educational initiatives becomes increasingly vital. This study aimed to assess the knowledge of the fertile period and associated factors among AGYW in Tanzania for evidence-based interventions. An analytical cross-sectional study was conducted using secondary data from the 2022 Tanzania demographic and health survey. Given the survey's complex design, weighted binary logistic regression model was used to determine factors associated with knowledge of the fertile period. Adjusted odds ratio (AOR) with corresponding 95% confidence intervals (CI) were used to estimate the strength of the association. A p-value of < 0.05 was declared statistically significant. The overall prevalence of knowledge about the fertile period was 19.4% (95% CI: 17.9-20.9). Several factors were associated with a higher likelihood of having knowledge about the fertile period; being aged 20-24 years (AOR = 1.43, 95% CI: 1.16-1.76), having secondary education (AOR = 3.15, 95% CI: 2.23-4.45), exposure to media (AOR = 1.28, 95% CI: 1.02-1.59), visiting a health facility in the past 12 months (AOR = 1.40, 95% CI: 1.29-1.66), and residing in the central (AOR = 2.55, 95% CI: 1.67-3.89) or southern zones of mainland Tanzania (AOR = 1.67, 95% CI: 1.11-2.48). This study revealed the factors impacting knowledge of fertile period among AGYW, highlighting the roles of educational attainment, media exposure, healthcare access, and geographical location. Increased education and health service access correlate with better knowledge. To address these challenges, tailored interventions that account for above would be essential. ​Ultimately, enhancing fertile period awareness necessitates engaging educational programs across various platforms, empowering AGYW to make informed reproductive health choices. Further research needs to be conducted to monitor the knowledge on fertile periods.

Background: The study aimed to evaluate the efficacy of a combination of Dioscorea villosa (containing diosgenin), vitamin D, and α-lactalbumin, in women with Polycystic Ovary Syndrome (PCOS) phenotype D. The primary objective was to investigate improvements in menstrual cycle regularity. Methods: A total of 24 women aged 22–34 years with PCOS phenotype D received daily supplementation with 600 mg Dioscorea villosa (120 mg diosgenin), 100 mg α-lactalbumin, and 50 μg vitamin D for six months. Clinical and biochemical assessments, including hormonal profiling and menstrual cycle monitoring, were conducted at baseline (T0), after 3 months (T1), and after 6 months (T2). Results: The treatment led to a statistically significant improvement in menstrual cycle regularity: eumenorrhea was achieved in 50% of patients at T2, compared to 0% at baseline. Significant changes were also observed in luteinizing hormone (LH), follicle-stimulating hormone (FSH), and the LH/FSH ratio, alongside a reduction in insulin and HOMA-index at T1. No adverse events were reported. Conclusions: The combination of Dioscorea villosa, vitamin D, and α-lactalbumin promotes menstrual cycle regularization in women with PCOS phenotype D. The positive result suggests a beneficial role of the treatment when administered to this specific subtype of PCOS and supports the use of targeted nutraceutical therapy as an alternative to conventional treatments, especially in non-hyperandrogenic PCOS patients.

Introduction Negative menstrual cycle–related symptoms have been shown to perceptually impact well-being, as well as training and competition performance, yet they are rarely daily monitored over extended periods. The aim is to compare menstrual cycle (MC) and hormonal contraception (HC) related symptoms reported through retrospective and daily questionnaires in elite female athletes and to assess their association with well-being and performance metrics. Methods Data were collected from 108 elite female athletes across seven sports over 554 full cycles. Participants completed a retrospective questionnaire on regular symptoms and provided daily prospective entries for 6 months ( n = 16,491) about their symptoms, sleep, fitness and mood. Symptom reporting methods were compared, differences in symptom frequency across cycle phases were analyzed, and associations between symptom count and well-being were explored. Performance metrics were collected for sports providing objective data and analyzed comparing training with vs. without reported symptoms. Results Athletes reported more symptoms retrospectively than in daily questionnaires. Mood swings, tiredness, and pelvic pain were the most common retrospective symptoms, while bloating, tiredness, and pelvic pain were most frequent in daily entries. MC athletes reported more symptoms than HC users in both methods. According to the daily follow-up, symptoms were more frequent during menstruation and the prebleeding phase for MC athletes and the break phase for HC users. A significant negative correlation was observed between symptoms and well-being indicators. In football players, high-speed running distance significantly declined on symptomatic days. Conclusion Retrospective questionnaires shows a greater symptom prevalence than daily monitoring. Symptoms, more frequent during bleeding phases, negatively impacted athletes' well-being and also high-speed running performance for football players. These findings highlight the importance of individualized monitoring and tailored interventions to optimize athlete health, well-being, and performance.

Introduction Acute exposure to air pollution negatively affects athletes’ ability to perform at their best, with a more pronounced impact observed in females. Despite this, the representation of female-only cohorts is lacking. This study investigates how exposure to air pollution impacts performance and well-being of an elite female soccer team. Methods Comprehensive data on external, internal, and subjective load variables were combined with the concentrations of three major air pollutants (Particulate Matter &amp;gt;10 µm and Oxidant (Ox = Ozone + Nitrogen Dioxide) during soccer training and matches in the 2022–23 season. Linear mixed-effects models assessed performance parameters such as distance ran, heart rate, rating of perceived exertion (RPE), accounting for confounding factors such as weather and menstrual cycle phase. Results No significant impairments in the physical or physiological demands of athletes were observed with increasing pollution concentrations, nor did athletes’ well-being appear to be disturbed. However, RPE increased by 0.84 units ( p &amp;lt; .001) if athletes played soccer when exposed to Ox levels above 98.3 (µg/m 3 ). Interestingly, this undesirable increase in RPE was mitigated if athletes were also exposed to high levels of Ox in the seven sessions leading up to this event (−0.5 units, p &amp;lt; .001). Discussion While objective performance measures remained largely unaffected by moderate levels of air pollution, players subjectively experienced a heightened sense of effort. Additionally, an acclimation effect was observed regarding preceding Ox exposure, whereby accounting for pre-event exposure levels to Ox appeared to mitigate the negative impact of high Ox levels on RPE.

The present study compared changes in body temperature during sleep, sleep quality (eg, subjective and objective sleep parameters) between middle-aged women and young women. Nineteen middle-aged women and 14 young women with normal menstrual cycles were recruited. Over 7 consecutive days, skin temperature and sleep parameters (subjectively and objectively analyzed using the Pittsburgh Sleep Quality Index [PSQI] and actigraphy, respectively) were assessed. For the PSQI, higher score means decreased quality of sleep. The skin temperature during sleep was significantly higher in middle-aged women (35.0 ± 0.4℃) than young women (34.6 ± 0.5℃, P < 0.05). In young women, skin temperature increased immediately after bedtime and then gradually decreased, whereas skin temperature did not decrease in middle-aged women (P < 0.05 between groups). In addition, skin temperature remained significantly higher in middle-aged women than young women during the 30%-80% phase for the entire night (P < 0.05). Middle-aged women had a significantly higher PSQI score (5.4 ± 0.4) than young women (3.9 ± 0.4, P < 0.05), indicating that sleep quality was impaired in middle-aged women. However, no significant difference was found in objective sleep parameters between middle-aged women and young women. Middle-aged women had significantly higher body temperatures during sleep than younger women. A sustained higher body temperature during sleep may be associated with decreased sleep quality, as evaluated by the PSQI.

The uterus exhibits dynamic peristaltic activity across the menstrual cycle, playing a critical role in reproductive processes such as sperm transport and embryo implantation. However, current imaging methods to assess this activity provide little information and are limited by subjectivity and lack of sensitivity. A recent pilot study has shown the potential of intracavitary electrohysterography (IC-EHG) to study peristalsis in the uterine fundus. This study aimed to generalize previous results, compare peristalsis in other uterine regions, and study more peristaltic features. This prospective multicenter cohort study included 40 healthy women with proven fertility. IC-EHG signals were recorded from different uterine sites for 30 min during three menstrual phases: mid-follicular (MF), early luteal (EL), and late luteal (LL) using a custom-designed multipolar catheter. contraction frequency (CT/min)and amplitude (μV); secondary outcomes: basal amplitude, contraction time percentage, contractility index and local organization index. Statistical comparisons between phases and regions were performed using Wilcoxon signed-rank tests. A total of 95 fundal and 90 lower-segment IC-EHG recordings were analyzed. Contraction frequency peaked during the EL phase (fundus: 3.91 CT/min; lower segment: 4.01 CT/min) and was lowest during MF (fundus: 3.28 CT/min, p = 0.042; lower segment: 3.65 CT/min, p = 0.024). Fundal contraction amplitude decreased progressively from MF (16.27 μV) to LL phase (10.56 μV, p < 0.001). Basal amplitude, contraction time percentage and contractility index were also lowest in the LL phase for both uterine regions. Except for frequency, fundus peristaltic activity features were smaller than those of the lower segment, significantly during the MF phase. Local coordination index revealed lower local cell organization in the fundus across all phases, with maximum coordination during EL in both regions (p < 0.01). IC-EHG technique enables objective, reproducible, and quantitative assessment of multiple aspects of uterine peristalsis, revealing distinct regional and cycle-phase-dependent patterns. The decline in most contractile features during the LL phase supports the physiological uterine quiescence required for embryo implantation. The uterine fundus is more active during the MF phase. This study provided reference values for healthy, fertile conditions and could inform further investigation of alterations due to disorders or intervention strategies.

Purpose: This study examined hydration responses to sodium hyperhydration in female athletes at rest and during cycling across the early follicular and mid-luteal phases of the menstrual cycle. Methods: Twelve cyclists/triathletes consumed 30 mL·kg−1 fat-free mass fluid with either sodium chloride (7.5 g·L−1) or placebo (sucrose) 2 h before 75 min of steady-state cycling (60% VO2peak) and a 200 kJ time trial (TT) in a hot environment (34 °C, 60% RH). Body mass was measured, and urine was collected every 30 min, whilst blood samples were taken hourly pre-exercise, post-steady-state, and post-TT. Results: During pre-exercise, sodium hyperhydration increased fluid retention (509.0 mL, 95% CI: [349.0, 669.0]; p &lt; 0.001), while reducing urine volume (−107.4 [−146.7, −68.1] mL; p &lt; 0.001). During exercise, body mass loss was lower with sodium during steady-state (−0.20%; p = 0.001) and TT (−0.15%; p = 0.037), but sweat rates were reduced with sodium only during steady-state (−0.08 L·h−1; p = 0.001). Exploratory analyses showed greater effects in the early-follicular phase, with reductions in body mass loss (−0.26%; p = 0.004), sweat rate (−0.1 L·h−1; p = 0.003), and post-TT arginine vasopressin (−10.8 [−19.2, −2.3] pg·mL−1; p = 0.013). Conclusions: Sodium hyperhydration effectively enhanced fluid retention and reduced body mass loss during exercise in the heat. While no consistent main effects of menstrual cycle phase were observed, some phase-specific differences emerged, particularly in the early-follicular phase. These findings highlight the importance of monitoring hydration responses across the menstrual cycle and tailoring strategies to individual needs, rather than applying universal phase-specific recommendations.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-age women, associated with insulin resistance, hyperandrogenism, and menstrual irregularities. Nutraceutical interventions-bioactive compounds derived from foods or supplements that provide health benefits beyond basic nutrition-may support conventional therapy. This study aimed to systematically evaluate the effects of nutraceutical interventions on reproductive and metabolic outcomes in PCOS. This systematic review and meta-analysis was registered in PROSPERO (CRD42024521879) and followed PRISMA 2020. Searches were performed in PubMed, Embase, Cochrane Library, Web of Science, and regional databases (January 2013-December 2024) and included 78 eligible studies. Eligible randomized and quasi-experimental studies assessed nutraceuticals such as vitamin D, inositol, and quercetin. Risk of bias was evaluated with standardized tools; certainty of evidence was graded by GRADE. Seventy-eight studies met inclusion criteria. Nutraceutical interventions significantly reduced fasting insulin (MD = -2.14 μIU/mL; 95% CI -3.12 to -1.16) and luteinizing hormone (MD = -1.34 mIU/mL; 95% CI -2.10 to -0.58) and increased sex-hormone-binding globulin (MD = +3.72 nmol/L; 95% CI 1.35 to 6.09). Vitamin D supplementation showed the strongest metabolic and hormonal improvements. Results for ovarian follicle count and menstrual bleeding were inconsistent. Nutraceutical interventions targeting metabolic and hormonal regulation may complement lifestyle therapy in women with PCOS. Interpretation is limited by study heterogeneity and variable methodological quality. No external funding was received.

To describe menstrual pain and pain management, and the associations of pain relief with school absenteeism and educational performance, among Ugandan adolescents. Cross-sectional mixed-methods study, nested within a school-based cluster randomised controlled trial. Adolescent girls in 60 secondary schools in Uganda. Quantitative surveys, focus group discussions and in-depth interviews were conducted. Data were analysed using thematic framework analysis for qualitative data, and random-effects regression analysis for quantitative data. Self-reported pain during the last menstrual period (LMP), school absenteeism and educational performance. Among 2683 participants, the majority (n = 2227; 83.0%) reported pain during their LMP and were more likely to miss school than those without pain (mean days missed per month 2.1 vs. 1.4; adjusted incidence rate ratio [aIRR] = 1.46, 95% CI 1.30-1.65). Participants reported that menstrual pain hindered their ability to engage at school, leading to reduced class attendance and participation. Pain management strategies (painkillers, warm water bottles, stretching, or exercise) were reported by 1587 (71.3%) participants with pain at LMP, and were less commonly reported among participants with mental health problems and poorer menstrual self-efficacy. Participants who did not report pain relief missed more school days than those who did report pain relief (aIRR = 1.39, 95% CI 1.11-1.74). Menstrual pain without effective relief was associated with increased school absenteeism. There is a need to improve the uptake of effective pain relief strategies in Ugandan schools and similar settings.