Menstruation-related participation difficulty and symptoms of depression and anxiety among adolescents and young women in Nepal

Abstract Background Contemporary definitions of menstrual health include the capacity to participate in work, education and social life; however, nationally representative evidence examining the association between menstruation-related functional difficulty and mental-health symptoms is lacking in Nepal. Methods Cross-sectional analysis of the Nepal Multiple Indicator Cluster Survey 2024–25. Participants were women aged 15–24 years who had menstruated in the preceding 12 months (n = 3,845 for prevalence; n = 3,772 analytic sample). The exposure was any menstruation-related difficulty participating in work, education/training, or social activities during the last menstrual period. The outcome was NMICS-defined depression and/or anxiety symptoms during the preceding two weeks, using survey-specific thresholds for depression (≥ 14) and anxiety (≥ 12). Survey-weighted logistic regression with marginal standardization estimated adjusted prevalence differences (aPD), controlling for age, residence, province, wealth, education, and current marital/union status. Results Weighted prevalence of any participation difficulty was 45.3% (95% CI 43.2–47.4); domain-specific prevalence was 41.7% for work, 31.8% for education/training, and 34.7% for social activities. Standardized prevalence of depression and/or anxiety symptoms was 7.7% (6.1–9.3) without difficulty and 16.8% (14.4–19.3) with difficulty, an aPD of 9.07 percentage points (6.34–11.81). Estimates were similar for depression (7.99; 5.59–10.39) and anxiety (8.34; 5.72–10.96), and in a post hoc analysis restricted to participants whose most recent menstrual period began within 14 days before interview (aPD 8.58 percentage points, 95% CI 5.02–12.14). Conclusions Nearly half of menstruating adolescents and young women aged 15–24 years in Nepal reported menstruation-related participation difficulty, and participation difficulty was associated with a higher prevalence of depression and/or anxiety symptoms.