Menstrual irregularity and associated factors among secondary school students in Areka Town, Southern Ethiopia: An institution-based cross-sectional study

Menstrual irregularity (MI) is a common reason for gynecological visits and significantly affects adolescents' physical health, psychosocial well-being, and academic performance. However, most studies in Ethiopia have predominantly focused on university students, creating a critical gap in understanding MI among younger secondary school students, particularly in Southern Ethiopia. This study aimed to assess the magnitude of MI and its associated factors among secondary school students in Areka Town, Southern Ethiopia. An institution-based cross-sectional study was conducted from December 18 to 31, 2023, involving 402 secondary school students selected through stratified random sampling. Data were collected using a pre-tested, semi-structured, self-administered questionnaire and anthropometric measurements. Data were entered into EpiData version 4.2, and analyzed using Statistical Package for Social Science version 25. Descriptive statistics summarized the variables. Bi-variable and multivariable logistic regression analyses were conducted to identify factors associated with MI. Results were presented in text, tables, and charts. The magnitude of MI among respondents was 59.5% (95% confidence interval (CI): 55-64%). Factors significantly associated with MI included: younger age ≤ 16 years [adjusted odds ratio (AOR) = 8.72, 95% CI: 2.73-27.81], being unmarried [AOR = 4.03, 95% CI: (1.19, 19.57)], hormonal contraceptive use [AOR = 6.07, 95% CI: 1.16-28.19], family history of MI [AOR = 4.03, 95% CI: 1.05-14.03], circumcision [AOR = 7.26, 95% CI: 2.87-18.35], and menarche at age ≤ 12 years [AOR = 3.62, 95% CI: 1.55-8.47]. Additionally, behavioral factors such as alcohol consumption [AOR = 4.72, 95% CI: 1.34-16.68], sleeping <7 hours per 24 hours [AOR = 2.94, 95% CI: 1.17-7.39], severe stress [AOR = 1.51, 95% CI: 1.01-4.24] and extremely severe stress [AOR = 3.08, 95% CI: 1.08-8.80] were independently associated with MI. More than half of the secondary school students experienced MI, which were associated with a mix of socio-demographic, reproductive, and modified behavioral factors. These findings strongly recommend the urgent implementation of comprehensive school-based menstrual health programs that integrate education on healthy lifestyle practices, stress management, and early screening for MI to mitigate its negative health and academic impact on young adolescents.