Background A large proportion of young people who menstruate report struggling with problematic menstrual symptoms that contribute to their school absences and negatively impact their ability to focus and be productive whilst at school. However, understanding of this relationship is limited by reporting bias and confounding and little is known about the impact on educational attainment. We aimed to explore whether adolescent heavy menstrual bleeding and menstrual pain had a detrimental effect on attendance at school and educational attainment.

Methods Participants were 2,698 girls from the Avon Longitudinal Study of Parents and Children, a prospective birth cohort study in the South West of England. Exposures were self-reported menstrual symptoms (heavy or prolonged bleeding and menstrual pain) during adolescence. Outcomes were school absences and attainment in qualifications at the end of compulsory schooling (age 16), which were captured through linked administrative data. Data were analysed using multivariable linear regression models, adjusting for a comprehensive range of confounders.

Results 36.0% of participants reported heavy or prolonged bleeding and 55.5% reported menstrual pain. Heavy or prolonged bleeding was associated with greater levels of school absence (16.6%; 95% CI: 9.4, 24.2; p value < 0.001) and lower educational attainment (-5.7 points; 95% CI: -10.1, -1.2; p value =0.013). Menstrual pain was also associated with more school absences (12.8%; 95% CI: 9.4, 23.6; p value < 0.001); however, there was little evidence for an association between menstrual pain and attainment (-3.14 points; 95% CI: -7.46, 1.17; p value = 0.153).

Conclusion School absences were higher in those with heavy or prolonged bleeding and pain and GCSE attainment was lower in those with heavy or prolonged bleeding. The results may suggest that school-based interventions to support young people suffering with problematic menstrual symptoms are needed to mitigate the adverse consequences.