Self-reported menstrual-related physical and psychological symptoms and health-seeking behaviour among rural school-going adolescent girls in Bangladesh

BACKGROUND: Menstrual Hygiene Management (MHM) is recognized globally as a public health concern; however, it remains a neglected issue in Bangladesh, particularly in rural communities. This study examined the self-reported prevalence and perceived severity of menstruation-related physical and psychological symptoms, their association with menstrual irregularity, and health-seeking behaviour among rural school-going adolescent girls. METHODS: A cross-sectional mixed-methods study was conducted among 474 grade 9-10 school-going girls in rural Sylhet division, Bangladesh, between September and November, 2024. Participants reported menstrual cycle characteristics and self-rated the severity of their common physical and psychological symptoms as mild, moderate, or severe. Menstrual cycle regularity was assessed through self-report. Symptom prevalence and severity distributions were summarised descriptively by cycle regularity group. Chi-square tests examined associations between menstrual irregularity and symptom severity. Qualitative in-depth interviews (n = 29) were conducted with purposively selected participants to contextualise quantitative patterns within broader sociocultural and structural determinants. RESULTS: Of 474 participants, 111 (23.4%) reported irregular menstrual cycles. Abdominal pain or cramps (77.2%), fatigue or weakness (69.4%), and joint or muscle pain (48.5%) were the most prevalent physical symptoms. Irritability (73.4%), mood swings (64.1%), and anxiety (58.6%) were the most common psychological symptoms. Menstrual irregularity was significantly associated with higher symptom severity for both physical (χ²(2) = 157.81, p < 0.001) and psychological (χ²(2) = 100.85, p < 0.001) outcomes; 49.5% of irregular-cycle girls reported severe physical symptoms versus 3.9% of regular-cycle girls, and 27.0% reported severe psychological symptoms versus 3.0%. Qualitative findings revealed that these high symptom burdens were systematically normalised through cultural beliefs, intergenerational transmission of avoidance strategies, and stigma-mediated communication failures, resulting in very low rates of formal health-care seeking irrespective of symptom severity. CONCLUSIONS: This study demonstrates that menstrual symptom burden, both physical and psychological, is substantial among rural adolescent girls in Bangladesh and is disproportionately severe among those with irregular cycles. These findings highlight the importance of integrating symptom recognition, stigma reduction, and accessible care pathways into health initiatives for adolescents. Given the cross-sectional and self-reported design, the results should be interpreted as exploratory but indicative of an important area for targeted public health attention in rural contexts.