The Silent Absence: How Menstrual Health Challenges Quietly Drain Education and Work Opportunities for Secondary School and University Women in Sub-Saharan Africa

Background: Menstruation is a normal biological process, yet for millions of adolescent girls and young women in sub-Saharan Africa it is a recurring source of pain, anxiety, shame and lost opportunity. Menstrual health challenges, including dysmenorrhoea, inadequate water, sanitation and hygiene (WASH) facilities, limited access to menstrual products, stigma and low menstrual health literacy, may undermine attendance, concentration and academic performance, with potential consequences that extend into working life. Evidence is fragmented across school and university settings and rarely connects education to employment. In Cameroon, peer-reviewed evidence is particularly sparse. Objective: To synthesise recent evidence (2022 onwards) on how menstrual health challenges affect the education of secondary school and university women, to explore implications for working life, and to propose a conceptual framework and research agenda for Cameroon and comparable settings.Methods: We conducted a narrative review of recent peer-reviewed literature and programme documentation published from 2022 onwards, focusing on sub-Saharan African and comparable low- and middle-income contexts. Findings were organised thematically across secondary school, university and workplace settings. Results: Recent studies consistently link menstrual pain, unsafe or unclean school facilities, urogenital symptoms, stigma and fear of teasing to missed school days and reduced participation. In a rural Gambian study, 27% of menstruating girls missed at least one school day per month, and extreme menstrual pain was associated with markedly higher odds of absence. Among Ethiopian university students, dysmenorrhoea prevalence reached 80%, with most affected students reporting reduced concentration and academic performance. Pooled estimates place dysmenorrhoea at roughly seven in ten students in Ethiopia. Workplace evidence is dominated by high-income settings and is scarce for menstrual disorders and for African women. Cameroon-specific peer-reviewed evidence since 2022 was not identified, although school-based programme pilots are under way. Conclusions: Menstrual health is an under-recognised determinant of educational equity and, by extension, of women’s economic participation. We propose the Menstrual Health–Education–Work Continuum, a framework linking individual, school or campus, household, and policy factors to learning and employment outcomes. Priority research includes standardised measurement of menstruation-related absence and performance, Cameroonian prevalence and impact studies, and trials of multicomponent interventions that address pain, facilities, products and stigma together.