Associations of adolescent menstrual symptoms with school absences and educational attainment: analysis of a prospective cohort study.

BackgroundMenstrual symptoms may negatively impact pupils attendance and educational attainment, but rigorous population-based studies are lacking. MethodsIn a prospective cohort study in England, we assessed associations of self-reported heavy or prolonged bleeding and menstrual pain with school absences and attainment, adjusting for potential confounders. FindingsOf 2,698 participants, 36% reported heavy or prolonged bleeding and 56% reported menstrual pain. Heavy or prolonged bleeding was associated with missing 1{middle dot}7 additional days of school per year (16{middle dot}58%; 95% CI: 9{middle dot}43, 24{middle dot}20), and 48% higher odds of being persistently absent ([≥]10% absent) (OR 1{middle dot}48; 95% CI: 1{middle dot}45, 1{middle dot}52). Menstrual pain was associated with missing 1{middle dot}2 additional days of school per year (12{middle dot}83%; 95% CI: 6{middle dot}14, 19{middle dot}95), and 42% higher odds of being persistently absent (OR 1{middle dot}42; 95% CI: 1{middle dot}39, 1{middle dot}46). Heavy or prolonged bleeding was associated with lower scores in compulsory examinations taken at age 16 (-5{middle dot}7 points; 95% CI: -10{middle dot}1, -1{middle dot}2, equating to one lower grade), and with 27% lower odds of achieving five standard passes (OR 0{middle dot}73; 95% CI: 0{middle dot}71, 0{middle dot}75). There was less evidence of an association between menstrual pain and examination scores (-3{middle dot}14 points; 95% CI: - 7{middle dot}46, 1{middle dot}17), but menstrual pain was associated with 16% lower odds of achieving five standard passes (OR 0{middle dot}84; 95 CI: 0{middle dot}81, 0{middle dot}86). InterpretationBoth heavy or prolonged bleeding and menstrual pain were associated with lower school attendance and educational attainment. Greater research and support are needed to enable girls to achieve their full academic potential. FundingWellcome Trust and UK Medical Research Council.