Prevalence and Contributing Factors of Menstruation-related Absenteeism among Schoolgirls: A Systematic Review Meta-Analysis

Menstruation often causes dysmenorrhea, affecting 50–90% of women and impairing daily activities. Among schoolgirls, pain, poor menstrual hygiene management (MHM), and cultural stigma contribute to absenteeism. This review examined the prevalence, duration, and contributing factors of menstruation-related absenteeism among schoolgirls.

PubMed, Scopus, Web of Science, and Cochrane Library were searched to February 2025. Eligible cross-sectional studies on primary and secondary schoolgirls were screened and extracted by two independent reviewers. Outcomes included prevalence, duration of absenteeism, and association with maternal illiteracy. Random-effects meta-analyses were conducted using R 4.3.3.

Fifty-four studies with 41,112 participants were analyzed. The pooled prevalence of menstruation-related absenteeism was 26.5% (95% CI: 21.98–31.89; I² = 99.1%). Absenteeism was highest in girls with severe pain (42.32%) compared to moderate (13.14%) and mild pain (11.37%) (p < 0.0001). Mean absence duration was 1.93 days (95% CI: 1.63–2.28). Maternal illiteracy was associated with higher odds of absenteeism (OR = 1.71, 95% CI: 0.91–3.22) but was not statistically significant (p = 0.0936).

Severe dysmenorrhea, inadequate MHM, and cultural restrictions are key drivers of school absenteeism. Infrastructure improvements and maternal education appear protective, but heterogeneity and inconsistent reporting limit generalizability.

Menstruation-related absenteeism remains a significant barrier to education for schoolgirls. Addressing pain management, hygiene infrastructure, and socio-cultural barriers is essential to improve attendance and equity.