Impact of menstrual cycle phases and dysmenorrhea on academic performance and psychosocial well-being among female university students in Yemen: A cross-sectional study at Ibb University

Background: Menstrual health is a key determinant of academic outcomes and psychosocial well-being among young women; however, evidence from resource-limited settings remains limited. This study examined the associations between menstrual cycle phases, symptom severity, and academic performance among female students at Ibb University, Yemen. Methods: This cross-sectional study, conducted between January 1 and March 31, 2025, enrolled 40 female students aged 22–30 years through convenience sampling. Prospective data collection included menstrual characteristics, academic absenteeism, concentration difficulties, perceived stress, anxiety, physical activity, sleep quality, and coping behaviors across the follicular, ovulatory, luteal, and menstrual phases. Multivariable logistic regression was used to identify the independent predictors of severe academic impairment, and interaction analyses assessed the effects of tribal affiliation and household income. Results: Absenteeism was highest during the menstrual phase, with 57.5% (23/40) reporting absence, compared to 7.5% (3/40) in the follicular phase [χ2(3) = 32.1; p < 0.001]. Concentration difficulties (mean score: 3.7 ± 0.8) and perceived stress (4.0 ± 0.8) were significantly elevated during menstruation (p < 0.001 for both). Severe menstrual symptoms affected 65.0% (26/40) of participants during the menstrual phase and were associated with lower exam scores (mean: 68.9% ± 9.2%) and reduced assignment completion (75.0% ± 18.0%) compared to other phases (all p < 0.001). Intersectional analyses indicated that marginalized tribal affiliation combined with low income increased the odds of absenteeism by more than sevenfold (adjusted odds ratio [aOR]=7.2; 95% confidence interval [CI]: 3.1–16.8; p < 0.001). Multivariable modeling identified dysmenorrhea severity (per 1-point increase, aOR = 1.4), cycle irregularity (aOR = 2.1), elevated stress (aOR = 1.5), marginalized tribal status (aOR = 2.8), and low household income (aOR = 2.4) as independent predictors of severe academic impact. Conclusion: Menstrual cycle-related symptoms substantially impair academic performance and psychosocial health, with disproportionate effects on socially and economically marginalized students, highlighting the need for culturally sensitive, equity-focused interventions. These findings highlight the necessity of targeting menstrual pain management and providing psychosocial support to promote educational equity in low-resource university settings.