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Menstrual hygiene management training in Kenyan school.
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Menstrual health

18 June 2026

Key facts

  • An estimated 2.1 billion women and adolescent girls worldwide menstruate, but robust research on menstruation is limited.
  • Menstruation is a natural bodily process, but people who menstruate experience it differently. The experience can be positive, neutral or uncomplicated, painful, shame-inducing or stigmatizing. Negative experiences with menstruation can strongly impact overall health and well-being.[1]
  • More than 2 out of 3 women and girls have pain with menstrual bleeding; for a smaller number of people, menstrual pain can be very severe and can happen at other times in the menstrual cycle.
  • Many people who menstruate experience heavy menstrual bleeding, which can lead to iron deficiency anaemia.
  • An estimated 500 million people who menstruate globally lack access to menstrual materials and appropriate facilities to meet their menstrual health needs, including water, sanitation and hygiene (WASH) according to data collected between 2000–2019.
  • Based on emerging national data, around two out of five schools (39%) provide menstrual health education.
     

Overview

An estimated 2.1 billion women and adolescent girls worldwide menstruate (1).

The menstrual cycle is a monthly cycle experienced by women, girls and some gender-diverse people. It is regulated by hormones and lasts on average between 21 and 35 days. In the first half of the menstrual cycle, the lining of the uterus thickens. Around halfway through the cycle, an egg is released from an ovary (ovulation), and, if there is no pregnancy at the end of the cycle, the blood and tissue lining of the uterus is shed as menstrual blood.

Menstrual health includes being informed and supported to menstruate with dignity before the first menstrual cycle (menarche), during the reproductive years and until the stage in later life when menstruation ends (perimenopause). People who menstruate should:

  • have timely access to accurate and age-appropriate information about menstruation;
  • be able to access and use effective and affordable menstrual materials and acceptable water, sanitation, hygiene (WASH) and waste management facilities and services;
  • be able to access timely diagnosis, care and treatment services for menstrual difficulties or disorders;
  • not be stigmatized as a result of menstruation; and
  • be able to freely decide whether and how to participate in different aspects of life during all phases of the menstrual cycle.

Scope of menstrual health

During menstruation, people who menstruate may have a range of symptoms in addition to menstrual bleeding, such as cramping or pain, bloating, headache and/or mood changes. Usually, such symptoms do not prevent them from going about their daily routines. While more than 2 out of 3 people who menstruate experience menstrual pain (2), it is often manageable with pain medicines and other therapies such as a hot water bottle or heat pads. However, for some people, menstrual pain can be very severe and can even happen when there is no menstrual bleeding. A 2023 study in 10 cities in South Asia and sub-saharan Africa found that almost half of menstruating women experience heavy menstrual bleeding (3), putting them at risk of iron deficiency anaemia. The menstrual cycle is strongly linked to mental health, and some people who menstruate experience anxiety, sadness or depressed mood, irritability or other mood changes over the course of the menstrual cycle, before or during menstrual bleeding. These symptoms can be severe enough to negatively affect quality of life, social relationships and participation in school or work.

Menstrual bleeding that is unpredictable, infrequent, very painful, heavy, and/or which occurs with upsetting mood changes or other symptoms that disrupt normal activities, could suggest an underlying health condition such as endometriosis, adenomyosis (when the tissue lining the uterus begins growing within the muscles of the uterus), fibroids, Von Willebrand’s disease or other bleeding disorders, polyendocrine metabolic ovarian syndrome (previously known as polycystic ovary syndrome or PCOS), premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), or early decline of ovarian function (primary ovarian insufficiency). Concerns about menstruation deserve to be heard and evaluated by health and care workers because they can greatly reduce quality of life and increase the risk of long-term illness.

Accurate and age-appropriate menstrual health education should be delivered to school-aged children before their first period. It should:

  • explain that menstruation is a natural bodily process that does not affect quality of life for most people;
  • describe how to use and dispose of (or wash, dry and re-use) menstrual materials that absorb or collect menstrual flow in ways that are healthy for people who menstruate and the environment;
  • inform them that worrisome symptoms such as pain, heavy bleeding, depressed or anxious mood, and absent or infrequent menstruation are valid reasons to seek health care; and
  • challenge negative social norms and myths related to menstrual blood and the menstrual cycle.

Without menstrual health education – or if it is inaccurate or delivered by untrained educators – people who menstruate, their peers, family and community members might ignore or accept serious symptoms or feel too embarrassed to ask for help or seek health care. Many health and care workers do not have enough training in menstrual health and may dismiss or minimize symptoms related to menstruation, leading to delayed or missed diagnosis of important health conditions.

According to modelling of WASH data collected between 2000–2019, an estimated 500 million people who menstruate globally lack access to the full range of materials, facilities and services that support menstrual health and allow them to menstruate with dignity (4). Many people who menstruate either do not have access to locally- or commercially-produced single use or reusable menstrual materials such as pads, tampons, menstrual underwear or menstrual cups, or they are too expensive. Instead, they use cloths, rags, leaves, paper or other items to absorb menstrual blood. Further, there are currently no global safety standards to ensure that locally- or commercially-produced menstrual materials are safe, high-quality, and free from harmful chemicals. People who menstruate may additionally lack access to safe, clean and private rooms in which they can change, wash and/or dry menstrual materials; wash their hands and bodies; and dispose of used menstrual materials in ways that do not harm the environment. This is important because, even if people who menstruate have enough menstrual materials that they like to use, well-functioning waste management systems for safely disposing of menstrual materials are essential for protecting human, animal and environmental health.

In many communities, people who menstruate may experience menstrual stigma, or negative attitudes, beliefs and practices related to menstruation. These beliefs and negative attitudes vary across cultures and intersect with other forms of stigma. Menstrual stigma can limit health and well-being, years of education completed, wages and income from paid work, and a sense of social and cultural belonging. Social norms and taboos regarding menstruation tend to spread the myth that menstruation is inherently dirty or unclean and something to be ashamed of, leading people who menstruate to feel that menstruation must be hidden or kept secret.

There is insufficient high-quality scientific research on menstruation. Having more high-quality evidence on menstruation could help health systems deliver better menstrual health care, support health policies that improve menstrual experience for people who menstruate, and change taboos and attitudes around menstruation.

Who is at risk?

As roughly half of the world’s population menstruates at some point in their lives, supporting people in all their diversity to realize menstrual health and to menstruate with dignity is a global issue.

According to emerging national data, around two out of five schools (39%) currently provide menstrual health education, meaning many people who menstruate do not receive age-appropriate menstrual health education before their first menstrual cycle.

Menstrual poverty is the lack of access to or availability of locally- or commercially-produced menstrual materials due to financial constraints. Menstrual poverty disproportionately affects people who menstruate in low-income, and conflict-affected and other humanitarian settings. An array of laws and policies can help to deliver widespread menstrual health education, make menstrual materials affordable, make sanitation facilities acceptable and accessible and enhance access to menstrual health services. Unmet need for menstrual health care, along with stigma and taboos associated with menstruation, can limit the opportunities and capacities of people who menstruate to achieve their potential, freely make their own life choices and lead dignified lives.

Underserved people who menstruate are at higher-than-average risk for poor menstrual health outcomes. This includes: people with intellectual and/or physical disabilities; people experiencing homelessness, incarceration and/or institutionalization; migrants and people who are affected or displaced by conflict, climate change and other humanitarian crises; adolescents and young people who do not attend school; agricultural labourers and people who work in the informal labour sector; people living with HIV; Indigenous people and people belonging to minority racial or ethnic groups; people who identify as lesbian, gay, bisexual, transgender, intersex or queer (LGBTIQ+); people who have experienced female genital mutilation; commercial sex workers; and people who are otherwise economically marginalized.

WHO response

WHO promotes healthy, dignified and discrimination-free menstruation for all that is grounded in human rights, gender equity and social justice. WHO works with Member States and partners to address menstrual health as part of its overall work to improve women’s health and well-being globally. This includes the development of global guidelines on menstrual health. Global guidelines on endometriosis are also being developed. WHO additionally promotes menstrual health research that seeks to identify and elevate the most important unanswered questions related to menstrual health and works with governmental and nongovernmental partners to enhance awareness of menstrual health as a global public health issue.

WHO supports efforts to generate data and statistics to encourage Member States and partners to pay more attention to menstrual health, its outcomes and determinants across national health policies, services, and financing to ensure that people who menstruate in all their diversity can realize their rights to safety, being in charge over their own bodies), justice, and dignity.

 

References

(1) World Health Organization & United Nations Children’s Fund (UNICEF) (2025). Progress on household drinking water, sanitation and hygiene 2000-2024: special focus on inequalities. World Health Organization. https://iris.who.int/handle/10665/383246. License: CC BY-NC-SA 3.0 IGO.

(2) de Arruda GT, Barbosa-Silva J, Driusso P, Pathmanathan C, Armijo-Olivo S, Avila MA. Worldwide prevalence of dysmenorrhea: a systematic review and meta-analysis across 70 countries. Pain. 2026 Jan 1;167(1):41-55. doi: 10.1097/j.pain.0000000000003768.

(3) Sinharoy SS, Chery L, Patrick M, Conrad A, Ramaswamy A, Stephen A, Chipungu J, Reddy YM, Doma R, Pasricha SR, Ahmed T, Chiwala CB, Chakraborti N, Caruso BA. Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study. Lancet Glob Health. 2023 Nov;11(11):e1775-e1784. doi: 10.1016/S2214-109X(23)00416-3. Epub 2023 Oct 3. Erratum in: Lancet Glob Health. 2023 Dec;11(12):e1862. doi: 10.1016/S2214-109X(23)00507-7.

(4) World Bank. (n.d.). Menstrual health and hygiene. World Bank. https://www.worldbank.org/en/topic/water/brief/menstrual-health-and-hygiene. Accessed 15 May 2026. 

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[1] In this fact sheet, the term “people who menstruate” is used inclusively to refer to all women, girls and gender-diverse people who menstruate.