Associations between physical activity, sleep patterns and diet quality and menstrual health symptoms in midlife: evidence from the 1970 British Cohort Study

Abdullayev K, Kamilla Abdullayev, John Joseph Mitchell, Mitchell JJ, Blodgett JM, Joanna M Blodgett
BMC women's health · 2026 · vol. 26(1) · doi:10.1186/s12905-026-04533-9 · PMID:42192416 · PMC13386675
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Lower diet quality was associated with reduced odds of PMS, while lower moderate-vigorous physical activity and sleep regularity were associated with increased odds of painful and heavy periods.

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This study used data from 2,109 women in the age 46 sweep of the 1970 British Cohort Study to examine associations between diet quality (Mediterranean diet score from a 24-hour Oxford WebQ), physical activity (thigh-worn accelerometers over 7 days) and sleep patterns (duration, efficiency, regularity) with self-reported menstrual health symptoms (heavy periods, painful periods, PMS). In adjusted logistic regression models controlling for factors including BMI, education, smoking, contraception, irregular bleeding, and endometriosis diagnosis, the lowest diet quality quartile showed reduced odds of PMS, while total physical activity showed no significant associations. In contrast, lower moderate-vigorous physical activity and poorer sleep regularity were associated with higher odds of painful and heavy periods, and sleep duration was not associated with outcomes; some sleep efficiency effects appeared only in unadjusted analyses. The paper’s cross-sectional design and self-reported symptom measures limit causal interpretation. Relevance to endometriosis: the models explicitly adjusted for an endometriosis diagnosis, though endometriosis was not the study’s primary focus.

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Abstract

BACKGROUND: Menstrual health symptoms, including painful periods, heavy bleeding, and premenstrual syndrome (PMS), are prevalent in midlife women and may be influenced by lifestyle factors. Identifying modifiable health behaviours associated with these symptoms could inform non-pharmacological interventions. This study examined the associations between diet quality, physical activity, and sleep patterns with menstrual health symptoms in midlife women using data from the 1970 British Cohort Study. METHODS: Participants (N = 2,109) were drawn from the age 46 sweep of the 1970 British Cohort Study, a birth cohort of individuals born within a single week. Dietary data was collected using the 24-hour Oxford WebQ questionnaire and a Mediterranean diet score was derived as an indicator of diet quality. Physical activity (total time and moderate-vigorous physical activity) and sleep patterns (duration, efficiency, regularity) were measured via thigh-worn accelerometers for a 7-day wear period. Quartiles were derived for each continuous exposure, with the healthiest quartile as the reference group. Binary menstrual health outcomes (heavy periods, painful periods, PMS) were self-reported. Binomial logistic regression models estimated associations between individual lifestyle factors and each menstrual symptom, adjusting for irregular menstrual bleeding, contraception use, body mass index (BMI), education, endometriosis diagnosis, smoking status and cohabiting status. RESULTS: Approximately half of participants reported experiencing painful periods (44.1%), heavy periods (51.8%) or PMS (49.5%). Participants in the lowest quartile of diet quality had reduced odds of experiencing PMS symptoms (adjusted OR: 0.75, 95% confidence interval (CI): 0.57, 0.98)). There was no significant association between total physical activity and any of the menstrual symptoms in adjusted models, however, those in the lowest quartile of moderate-vigorous physical activity had 1.35 (1.01, 1.80) times higher odds of having painful periods and 1.33 (0.99, 1.79) times higher odds of having heavy periods in adjusted models. There were no associations with PMS and any physical activity variable. Those in the lowest sleep regularity quartile had 1.43 (1.08,1.91) higher odds of experiencing painful periods, 1.34 (1.00,1.79) higher odds of heavy periods and 1.33 (1.01,1.76) higher odds of PMS in adjusted models. Lowest levels of sleep efficiency showed 1.41 (1.07,1.84) higher odds of painful periods in unadjusted models. Sleep duration was not associated with any menstrual health outcomes. CONCLUSIONS: Findings suggest that specific lifestyle behaviours, such as moderate-vigorous physical activity and sleep regularity, are associated with lower risk of painful periods, with further evidence indicating sleep regularity is also associated with heavy periods and PMS. Future research should explore potential causal relationships and intervention strategies to improve menstrual health through lifestyle modifications.
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Abstract

Background Menstrual health symptoms, including painful periods, heavy bleeding, and premenstrual syndrome (PMS), are prevalent in midlife women and may be influenced by lifestyle factors. Identifying modifiable health behaviours associated with these symptoms could inform non-pharmacological interventions. This study examined the associations between diet quality, physical activity, and sleep patterns with menstrual health symptoms in midlife women using data from the 1970 British Cohort Study.

Methods

Participants (N = 2,109) were drawn from the age 46 sweep of the 1970 British Cohort Study, a birth cohort of individuals born within a single week. Dietary data was collected using the 24-hour Oxford WebQ questionnaire and a Mediterranean diet score was derived as an indicator of diet quality. Physical activity (total time and moderate-vigorous physical activity) and sleep patterns (duration, efficiency, regularity) were measured via thigh-worn accelerometers for a 7-day wear period. Quartiles were derived for each continuous exposure, with the healthiest quartile as the reference group. Binary menstrual health outcomes (heavy periods, painful periods, PMS) were self-reported. Binomial logistic regression models estimated associations between individual lifestyle factors and each menstrual symptom, adjusting for irregular menstrual bleeding, contraception use, body mass index (BMI), education, endometriosis diagnosis, smoking status and cohabiting status.

Results

Approximately half of participants reported experiencing painful periods (44.1%), heavy periods (51.8%) or PMS (49.5%). Participants in the lowest quartile of diet quality had reduced odds of experiencing PMS symptoms (adjusted OR: 0.75, 95% confidence interval (CI): 0.57, 0.98)). There was no significant association between total physical activity and any of the menstrual symptoms in adjusted models, however, those in the lowest quartile of moderate-vigorous physical activity had 1.35 (1.01, 1.80) times higher odds of having painful periods and 1.33 (0.99, 1.79) times higher odds of having heavy periods in adjusted models. There were no associations with PMS and any physical activity variable. Those in the lowest sleep regularity quartile had 1.43 (1.08,1.91) higher odds of experiencing painful periods, 1.34 (1.00,1.79) higher odds of heavy periods and 1.33 (1.01,1.76) higher odds of PMS in adjusted models. Lowest levels of sleep efficiency showed 1.41 (1.07,1.84) higher odds of painful periods in unadjusted models. Sleep duration was not associated with any menstrual health outcomes.

Conclusions

Findings suggest that specific lifestyle behaviours, such as moderate-vigorous physical activity and sleep regularity, are associated with lower risk of painful periods, with further evidence indicating sleep regularity is also associated with heavy periods and PMS. Future research should explore potential causal relationships and intervention strategies to improve menstrual health through lifestyle modifications. Similar content being viewed by others Abbreviations - PMS: - Premenstrual syndrome - HRT: - Hormone replacement therapy

Acknowledgements

We would like to acknowledge the ProPASS consortium, and in particular Dr Matthew Ahmadi for supporting the accelerometery processing. Funding KA is supported through a Medical Research Council funded Doctoral Training Programme (MR/W006774/1), JJM is supported through a Cancer Research UK (Grant No. PRCPJT-Nov23/100005), JMB is supported through a British Heart Foundation grant (SP/F/20/150002). Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate Ethical approval is obtained from a National Health Service Research Ethics Committee in advance of each sweep of data collection. For the Age 46 sweep, ethical approval was provided by NRES Committee Southeast Coast - Brighton and Sussex (Ref 15/ LO/1446). Participants gave informed consent to participate in the study before taking part. All work involving human participants was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2008. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Abdullayev, K., Mitchell, J.J. & Blodgett, J.M. Associations between physical activity, sleep patterns and diet quality and menstrual health symptoms in midlife: evidence from the 1970 British Cohort Study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04533-9 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04533-9

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