Menstrual tracking app use in menstrual health self-management: A cross-sectional survey of user concerns, goals, and strategies

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Shea, Kirsten Weber, Cornelia Hainer, Marta Gómez Vargas, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7096664/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Disruptive menstrual symptoms are often normalized, contributing to delayed care and reliance on self-management. Menstrual tracking apps (MTAs) are widely used to monitor cycle-related experiences, yet little is known about their role in menstrual health management or healthcare engagement. We conducted a global cross-sectional survey of Clue MTA users (n = 11 910) assessing menstrual health experiences, healthcare interactions, and app use. Two-thirds reported being worried about their cycles or symptoms. Among those, 47% experienced severe symptoms. Just over half (53%) had spoken to a healthcare provider, but only 9% felt they were managing well with current treatments. Most (59%) were attempting to manage on their own. Users reported tracking improved feelings of period preparedness (96%), cycle awareness (90%), control over health (72%), and confidence speaking to healthcare providers (60%). MTAs may offer meaningful support for menstrual management, reflecting both their value to users and ongoing gaps in care and cultural support. Health sciences/Health care Health sciences/Medical research Figures Figure 1 Figure 2 Figure 3 Introduction Nearly all menstruating persons experience some degree of discomfort or disruption to daily life related to their menstrual cycle, whether due to bleeding, pain, fatigue, or other physical or emotional changes. 1 , 2 The pervasiveness of these experiences often leads to their normalization regardless of their severity, impact on quality of life, or economic cost to the individuals and the workforce. 3 , 4 This conflation of ‘common’ with ‘normal’ can obscure the need for medical attention and support, leaving significant concerns unaddressed. 5 This normalization is not only medical but also cultural, shaped by long standing societal narratives that frame menstruation as private, inevitable, and something to be endured rather than treated. 6 Societal stigma surrounding menstruation, coupled with the historical marginalization of female health, further reinforces secrecy, self-management, and endurance without complaint or accommodations. 7 , 8 An increasingly common strategy for menstrual health self-management is cycle tracking, which has been shifting from paper calendars to digital platforms. 9 , 10 Over the past decade, menstrual tracking apps (MTAs) have surged in popularity, with an estimated one-third of reproductive-aged women in the U.S. using such tools. 9 MTAs enable users to log a range of cycle-related information from bleeding patterns and cycle-related experiences (e.g., pain, fatigue, mood changes) to broader health indicators such as sleep and libido. Many also offer predictive insights, forecasting the most likely onset of future periods and the potential recurrence of specific experiences or symptoms. 10 , 11 Importantly, MTAs offer more than record-keeping. Users can actively engage with their data to anticipate recurring experiences, plan daily activities, and manage emotional and physical wellbeing. 10 – 12 These tools may also help individuals reflect on the patterns and impact of their experiences, prompting healthcare conversations that might not otherwise occur. However, despite widespread MTA use, there has been little systematic investigation into the scope and severity of users’ cycle-related concerns, the extent to which disruptive symptoms are self-managed, or how MTAs contribute to daily functioning, symptom interpretation, or engagement with healthcare. To address these gaps, we surveyed users of the Clue MTA to explore their menstrual health experiences, the challenges they face, and the role of their MTA in supporting self-management and clinical engagement. By examining both the benefits and limitations of MTA use, this study aims to contribute to a deeper understanding of how digital tools can support menstrual health and inform the development of more responsive, gender-equitable healthcare systems. Results Demographics and health status A total of 11 910 individuals completed the survey. Respondents were 18–58 years old (mean = 30, sd = 8) and represented 137 countries (Table S1 ). A majority (67%) had a university degree or higher; 71% rated their current overall health as good or very good. Nearly all respondents (96%) had been using an app to track their menstrual cycles for at least a year; 48% had been using an app for ≥ 5 years. Menstrual cycle concerns A majority of respondents (66%, Fig. 1 ) indicated worrying about their menstrual cycle or related symptoms. The most frequently reported reason for worry was managing daily life when experiencing symptoms (63%, Table S2). Fewer respondents were concerned about their health and/or fertility (43%) or being prepared for menstrual symptoms (36%); 34% selected more than one reason for worry. Cycle-related health issues Of those with worries, 59% thought that they may have a cycle-related health issue and 25% had a known issue (Fig. 1 ). At least half of respondents in all groups—no suspected, potential, or known cycle-related issues—reported concern about managing daily life when experiencing symptoms (Table 1 ). This was highest among those with a known condition (73%). Table 1 Reported reasons for cycle-related worries and whether respondent suspected a health issue (n = 7 898; those with worries) Cycle-related health issues None (n = 1 285; 16%) Potential (n = 4 625; 59%) Known (n = 1 988; 25%) Reason for worry a Managing daily life while having symptoms b 666 (52%) 2 862 (62%) 1 451 (73%) Health and/or fertility c 490 (38%) 2022 (44%) 902 (45%) Being prepared for symptoms d 549 (43%) 1628 (35%) 701 (35%) a More than 1 answer could be selected b (χ²(2, n = 7 898) = 156.43, p < 0.001; Follow-up tests: None vs. Potential, p < 0.001; None vs. Known, p < 0.001; Potential vs. Known, p < 0.001). c (χ²(2, n = 7 898) = 17.78, p < 0.001; Follow-up tests: None vs. Potential, p < 0.001; None vs. Known, p < 0.001; Potential vs. Known, p = 0.2) d (χ²(2, n = 7 898) = 26.17, p < 0.001; Follow-up tests: None vs. Potential, p < 0.001; None vs. Known, p < 0.001; Potential vs. Known, p = 0.98) Symptom experiences Body pain, emotional symptoms, and tiredness/low energy were the most commonly reported symptoms of concern, each selected by over 70% of respondents with worries (Table S3). The symptoms identified as most concerning were body pain (30%) and emotional symptoms (23%). Among those with worries, 47% rated their symptoms as “severe”, and 43% reported a substantial impact on daily life (Table 2 ). Of those without worries, 15% rated their symptoms as “severe” and 10% indicated a substantial impact. Table 2 Symptom severity and impact on quality of life Considering all of your menstrual cycle symptoms together, how would you rate the overall severity of your menstrual cycle experience? (Scale from 0–10, \(\:\ge\:\) 7 is considered severe) How much impact do your menstrual symptoms have on your overall quality of life? (-2 = no impact, 2 = a tremendous impact) Subgroup n Median Mode n(%) \(\:\ge\:\) 7 n Median Mode n(%) with ‘a lot’ or ‘tremendous’ impact Has worries 7 898 6 (IQR: 5–7) 7 3 709 (47%) 7 898 0 (IQR: -1-0) 0 3 408 (43%) No worries 4 005 4 (IQR: 3–6) 5 615 (15%) 4 005 0 (IQR: 0–1) 0 391 (10%) A majority of respondents with worries were managing their symptoms as best they could on their own (59%; Table 3 ). When considering diagnostic status: 67% with no suspected issues, 60% with a potential issue, and 50% with a known issue were self-managing (Table S4). Table 3 Symptom management status (n = 7 852; those with worries and a specified symptom of concern) Which of the following best describes where you are at in your journey with your symptom(s)? n (%) I am just dealing with my symptoms as best I can on my own 4 612 (59%) I am trying to decide whether something is wrong or not 1 298 (17%) I am managing well with my current treatments or strategies 680 (9%) I am working with a healthcare provider to try to improve my symptoms 619 (8%) I believe something is wrong and am working with a healthcare provider to find the cause / to get a diagnosis 439 (6%) I am waiting for surgery / to start a new treatment 96 (1%) I don’t think about them much (blocks other options) or no answer 108 (1%) Only 9% indicated managing well with current treatments (Table 3 ). The most common management strategies were pain medications (63%) and symptom tracking, such as with an app (57%)(Table S5). Healthcare experiences About half (53%) of respondents with worries had spoken to an HCP; 12% had not and did not plan to (Table 4 ). The most common outcome was being told that their symptom was normal / not a problem (34%); 29% received a diagnosis or treatment. Similar proportions were satisfied (40%) vs dissatisfied (43%) with their healthcare experience. Table 4 Healthcare experiences of respondents with cycle-related worries n (%) Have you spoken to a healthcare provider (HCP) about this symptom? (n = 7 852, those with worries and a specified symptom of concern) Yes 4 128 (53%) No and I don't plan to 925 (12%) Not yet, I am still deciding if it is a problem 2044 (26%) Not yet, but I plan to 755 (10%) What was the result of your conversation with your healthcare provider(s)? (n = 4 128, those with worries who had consulted an HCP) I received a diagnosis or treatment for my symptom(s) 1 193 (29%) I was told it is normal / not a problem 1 391 (34%) I am still working with healthcare providers to figure it out 7 80 (19%) My healthcare providers didn't know what to do / can't figure it out 349 (9%) Other - please specify: 409 (10%) No answer 6 (< 1%) How satisfied were you with your experience with your healthcare provider(s)? (n = 4 128, those with worries and a specified symptom of concern) Very satisfied 474 (12%) Somewhat satisfied 1 159 (28%) Neither satisfied nor dissatisfied 717 (17%) Somewhat dissatisfied 985 (24%) Very dissatisfied 788 (19%) No answer 5 (< 1%) What were the biggest challenges in getting support with your menstrual symptom(s)? (n = 7 852, respondents with worries and a specified symptom of concern) *multiple options could be selected except with “it was not a challenge” Healthcare providers didn't take my concerns seriously 1 996 (25%) Healthcare providers didn’t know what to do / couldn’t figure it out 1 372 (18%) It was difficult to arrange visits with healthcare providers 906 (12%) Visiting healthcare providers was expensive 885 (11%) I didn't have access to the right healthcare providers 383 (5%) Other - please specify 434 (6%) It was not a challenge to get support (blocks other options) or no answer 4 594 (59%) Of those that had consulted an HCP, 59% indicated that it was not a challenge to get support. However, 25% felt they had not been taken seriously and 18% said HCPs didn’t know how to help. Challenges related to menstrual health The most common challenges for those with worries were managing daily life with symptoms (62%), managing the stress and emotional burden of symptoms (54%), and trying to determine if there was an issue (42%) (Table 5 ). Only 6% indicated that everything felt manageable. Table 5 Biggest challenges related to menstrual health (n = 7 898, those with worries) *multiple options could be selected n (%) In general, what are your biggest challenges related to your menstrual health? Managing my daily life while having my symptoms 4928 (62%) Managing the stress / emotional burden of my symptoms 4271 (54%) Trying to figure out if there is an issue 3296 (42%) Trying to improve my symptoms 3161 (40%) Getting taken seriously by healthcare providers 2294 (29%) Getting a diagnosis for my symptoms 1666 (21%) Getting access to the right healthcare providers 1236 (16%) Paying for healthcare / treatments related to my symptoms 1176 (15%) Managing the logistics of healthcare (such as transportation and time for appointments) 786 (10%) Other 88 (1%) Everything currently feels manageable (blocks other options) or no answer 434 (6%) MTA use Regarding tracking goals, 94% of those with worries wanted to record their periods and get predictions; 62% aimed to understand or identify symptom patterns, and 27% already knew their patterns and tracked to be prepared (Table S6). Nearly all agreed tracking helped them feel more prepared for their period (96%; Fig. 2 ; Table S7). Large majorities also reported it helped them better understand their body and cycle patterns (90%) and made them feel more “in control” of their health (72%); 64% agreed they would have more health-related stress if they did not use Clue. Responses were similar for the full cohort of respondents (with or without worries) (Table S8). Focusing on symptom management, a majority of respondents with worries agreed that tracking helped them feel more prepared (81%) and increased their confidence in speaking with a healthcare provider (60%). Half (50%) felt tracking validated their feeling that something might be wrong, 36% said it helped them identify symptom triggers/alleviators, and 31% reported that it helped them uncover a potential health issue (Fig. 3 / Table S9). Of those who saw a provider, 59% said that tracking helped them decide to initiate a conversation. Of those with cycle-related worries, 91% were satisfied with the Clue app, 7% were neutral, and 2% were dissatisfied. The proportions were similar for the full study cohort (Table S10). Discussion Regardless of their impact, menstrual cycle-related symptoms are often trivialized, leaving many to manage their health concerns with little meaningful support. In this study, 66% of respondents expressed concern about their cycle experiences, and 94% reported ongoing challenges related to their menstrual health. While around half had consulted an HCP and nearly a third had received a diagnosis, most continued to struggle with symptom management, often relying solely on self-management strategies. MTAs were commonly used to track symptoms, identify patterns, and prepare for upcoming cycles, thereby giving users a greater sense of control over their menstrual health. Importantly, many of the reported experiences were not mere inconveniences. Nearly half of those with concerns rated their symptoms as severe and significantly disruptive to daily life. Even among those without explicit concerns, more than one in six reported severe symptoms. Notably, nearly half of concerned respondents had not spoken to an HCP, and a quarter were unsure whether their symptoms warranted medical support. When asked about their biggest menstrual health challenges, over 40% indicated struggling to determine whether there was a health issue or not. These findings echo a recurring theme in the literature: considerable cycle-related physical or psychological discomfort are often perceived as "normal" or an unavoidable consequence of having a female body. 2 , 13 – 16 Internalization of this framing can make it difficult to recognize whether symptoms warrant medical attention, leading many to hesitate, second-guess themselves, or assume their experiences do not justify care. In an open response question, one respondent demonstrated this conflict, stating: “There’s nothing wrong with me, my symptoms are 100% normal and within the typical range, but it still hurts too much to go on about my day like nothing’s wrong. I feel stuck…” This dynamic has been described as a paradox or catch-22, in which the female body is viewed as inherently debilitated, yet personal accounts of pain or dysfunction are routinely minimized. 5 Mild discomfort may be pathologized, while debilitating symptoms are dismissed as “normal”, leaving individuals in a no-win situation. Seeking care risks embarrassment or dismissal; avoiding care contributes to continued suffering. This perception of menstrual suffering as “normal” is disempowering and is a significant contributor to diagnostic delays for conditions such as endometriosis. 15 , 17 Another barrier to help-seeking is the belief, shaped by both cultural expectations and lived experience, that effective treatment is not available. 13 As one respondent shared, “My symptoms profoundly affect my life, however, it has been this way my whole life. It is a given that I have to adapt or ignore my symptoms”. Another described the cost-benefit calculation many face: “The fear when something is wrong, but you don't know what it is, while knowing if you do try to see a doctor, there will be little to nothing they can do or say to make you feel better and it will all cost two weeks worth of wages.” Notably, prior research found that those with more severe symptoms are also more likely to believe no effective treatments exist. 18 A substantial body of research documents the difficulties many face when seeking care for menstrual health concerns, including being dismissed by clinicians, needing to continuously advocate for themselves, having to consult multiple providers, and often enduring long diagnostic delays and considerable financial burden. 19 , 17 , 20 – 22 These challenges have not abated over time. In our study, only 40% of respondents who sought care were satisfied with their experience and a quarter of those that consulted an HCP said their biggest challenge was getting taken seriously. Many were told that their symptoms were “normal” or not medically concerning, leaving some feeling dismissed and unsupported. One participant captured the frustration: “[It’s] stressful because the doctors all say they don't know what is going on but also say apparently these changes are normal and expected and everyone has this, but how am I supposed to deal with this?!” Another described the burden of prolonged self-advocacy: “I had to research on my own and track my symptoms in this app. Then go to the doctor and tell them what I specifically thought was wrong with me–endometriosis. I told them of all the times I went to the doctor–over at least 10 years–with endometriosis symptoms and was told they couldn't find anything wrong with me. I finally found a female gynecologist who listened and told me that it sounded like textbook endometriosis.” Even among those who received a diagnosis, many continued to struggle with unresolved symptoms. This reflects a persistent challenge: for many conditions affecting people who menstruate, diagnosis does not guarantee meaningful relief. 21 , 23 , 24 Individuals may encounter limited treatment options, lack of specialist knowledge, and inconsistent or outdated clinical guidelines. Individuals may also face comorbidities or a complex constellation of symptoms, making it difficult to identify approaches that fully address their needs. 25 , 26 Few respondents in our study reported successful symptom management with current treatments. Many were still seeking solutions or had given up entirely. One respondent wrote, “I bleed almost every two weeks to two and a half weeks. I had an ablation but it didn’t do anything to help my periods. I started birth control and it made things worse…so I quit. So I don’t do anything except track it.” Given the normalization of symptoms and the limitations of available care, it is unsurprising that many attempt to manage their health independently. Self-management, or self-care, refers to the strategies individuals use to monitor, interpret, and cope with their health outside of a clinical setting, such as tracking symptoms, adjusting daily routines, or using over-the-counter treatments. 27 In this study, nearly two-thirds of those with concerns reported attempting to manage their symptoms on their own. Notably, this tendency was consistent across diagnostic groups: even among those with a known condition, half were still relying on self-management. While self-management can be an appropriate and positive part of menstrual care, exclusive reliance on it, especially in the context of ongoing or severe symptoms, may signal broader systemic shortcomings. In such cases, self-management may be less an empowered choice than a reflection of limited options. When asked about their biggest menstrual health challenges, respondents frequently cited managing daily life and coping with the stress and emotional burden of their symptoms; fewer reported trying to alleviate their symptoms. This emphasis on adaptation over intervention may point to internalised expectations of endurance and a broader sense of resignation. One respondent shared, “I’ve had hellish periods for what feels like forever. I’ve tried talking to my GP, nurse, gynaecologist, but I feel like they think it’s nonsense…I’ve kind of given up and just try and manage as best as I can.” MTAs played a meaningful role in respondents’ health management practices, with the vast majority reporting satisfaction with their app experience. Most commonly, MTAs were used to anticipate periods and better understand symptom patterns. Most respondents agreed that using an MTA increased their sense of preparedness for periods and symptoms, enhanced awareness of cycle patterns, and provided a greater sense of control over their health. These reported benefits align closely with the challenges respondents selected–often navigating daily life and managing the emotional burden of their symptoms, rather than expecting direct symptom relief. Knowing what to expect can give individuals more options, whether by having menstrual products or medications ready, adjusting their schedule to accommodate anticipated challenges, or mentally bracing for difficult days. As one respondent noted, “Clue helps me make predictions for when my mental health symptoms may be worse so I can take precautions and feel able to wait for those difficult days to pass.” Another shared, “[I was] diagnosed with Primary Dysmenorrhea… I'm grateful to have the app to be able to literally plan life around period pain.” Although MTAs are generally not designed as clinical interventions, some respondents reported symptom improvement with their use, aligning with prior research suggesting that using MTAs may help reduce symptom burden. 28 , 29 However, more commonly, the act of tracking itself offered reassurance and validation, helping users to predict and contextualize their symptoms. As one respondent explained, “This app helps me keep track of the symptoms that affect my day to day and moods. It confirms what I’m going through is part of my cycle and not me failing as a human.” Another wrote, “Tracking my period with Clue makes me feel more in control of what’s happening although it can’t change my condition… ” MTAs can also serve as valuable complements to clinical care. Many respondents reported that using Clue helped them identify health issues, seek medical attention, or ultimately receive a diagnosis. As one respondent shared, “I was misdiagnosed with IBS as a teenager and only through tracking my cycle with Clue over the past year did I realize it was likely a gynecological issue… I was diagnosed with stage IV endometriosis”. MTAs may enhance clinical interactions by helping users recognize and articulate symptom patterns that warrant further investigation, and by providing a record of their experiences to share with HCPs. Consistent with this, many respondents reported that using an MTA increased their confidence in communicating with clinicians. This aligns with prior research finding that both users and providers view MTAs as useful tools for symptom tracking and supporting clinical conversations. 30 This study has several limitations. As the sample comprised MTA users, findings may not be generalizable to the broader menstruating population, who may differ in symptom profiles, health concerns, prevalence of conditions, and engagement with healthcare systems. Although demographically diverse, the sample was skewed toward participants from high-income countries. Additionally, this study focused on symptom management among users with menstrual cycle concerns and did not explore other common reasons for MTA use, such as general cycle tracking to support body awareness, cycle-based lifestyle planning, or fertility-related goals. In terms of survey design, participants were asked to focus on a primary symptom of concern, which may have limited the capture of broader menstrual health experiences. While some respondents reported known or suspected cycle-related conditions, we did not ask whether their selected symptom was associated with these conditions, limiting interpretability. Lastly, as respondents were likely to be more engaged users, findings may be biased toward more favorable app experiences. Notable strengths of this study include its large, international sample, offering one of the most comprehensive snapshots to date of MTA users’ menstrual health experiences and self-management practices. The findings provide valuable insight into the lived experiences of a diverse group of menstruators, while highlighting the evolving role of MTAs in supporting menstrual health, fostering body literacy and self-efficacy, and enabling more confident engagement with healthcare. At the same time, these reported benefits of MTAs must be understood within the broader context of persistent unmet need. Despite increased body awareness and the enhanced ability to prepare for symptoms, many respondents continued to experience significant symptom burden and were managing largely on their own. This reflects not only the limited availability and accessibility of effective treatments, but also enduring cultural norms that frame menstrual suffering as something to be tolerated rather than treated. HCPs are well positioned to help close this gap. By partnering with patients to better understand their concerns, proactively inquiring about menstrual health, and offering timely diagnosis and care, clinicians can play a transformative role in validating experiences and improving outcomes. MTAs may serve as valuable tools in this process, supporting individuals in tracking and articulating their symptoms, and facilitating more informed, collaborative clinical conversations. Ultimately, advancing menstrual health will require coordinated efforts across clinical practice, education, research, and digital health innovation to challenge entrenched norms, reduce diagnostic delays, and ensure that individuals are not left to navigate these challenges alone. Methods The study questionnaire (see Supplementary Materials) was developed in English and tested for comprehension and completeness via 12 interviews and 29 unmoderated tests. The final instrument comprised questions on demographic variables, self-rated overall health, menstrual cycle experiences, symptoms of concern and symptom management, personal goals for using the Clue MTA, and agree/disagree statements about the app’s usefulness. It also included an open-ended question and free-text fields where respondents could share additional information. Data collection Questionnaires were distributed to Clue app users in any country who were using period tracking mode with their app language set to English. Approximately 554 000 in-app recruitment messages were sent from May 5 to May 13, 2024; 28 333 people clicked through to the survey landing page, and 12 189 respondents consented and submitted their answers. Participants who were under 18 years old or had not menstruated in the previous three months were exited from the survey. Responses from 11 910 completed questionnaires were included in the final analyses. Analytical strategy Respondents to the question below were divided into two groups: 1) no cycle-related worries (“no worries”; response a; n = 4 005) and 2) has cycle-related worries (“those with worries”; responses b-e; n = 7 898) (Fig. 1 ). How worried are you about your menstrual cycle or related symptoms? Not worried Slightly worried Moderately worried Worried Very worried The following question was used to further divide those with worries into three groups: 1) no issues (response a; n = 1 285), 2) potential issues (response b; n = 4 625), and 3) known issues (response c; n = 1 988)(Fig. 1 ). Which of the following best describes how you think about your menstrual cycle experiences and any possibly related health issues? You can consider things like cycle regularity, bleeding heaviness, and cycle-related symptoms like pain or mood changes. I don’t think I have any cycle-related issues I think I may have (or am not sure if I have) a health issue that affects or is affected by my menstrual cycles I have a known health issue that affects or is affected by my menstrual cycles Statistical methods Descriptive statistics (counts, percentages, median, and mode) were calculated for respondent groups. Three Pearson’s chi-square tests were performed to evaluate the association between the three groups of cycle-related health issues and each category of reason for worrying about their menstrual cycle or related symptoms, separately, adjusting the alpha level to 0.05/3 = 0.0167 for running three separate tests. Post-hoc pairwise comparisons were conducted to further explore the differences between the three groups. Another Bonferroni correction was applied to account for multiple comparisons, further adjusting the alpha level to 0.0167/ 3 = 0.0056. All analyses were performed in R using the base statistical package. Declarations Data availability The data that support the findings of this study are available from the authors upon reasonable request. Acknowledgements This study was funded by Biowink GmbH. Author contributions AAS, CH, and KW conceptualized and designed the study. AAS developed and tested the survey instrument with support from CH, KW, and MGV. Data collection was coordinated by KW, AAS, and CH. KW conducted the analyses with support from MGV and VJV. AAS and VJV drafted the manuscript with contributions from all authors. All authors reviewed and approved the final version of the manuscript. Ethics declarations Competing interests All researchers involved in this study were employees or paid consultants of Biowink GmbH, the developers of the Clue app. Ethical approval and informed consent The study protocol was reviewed by WCG IRB (wcgirb.com) and deemed exempt. All participants provided informed consent to participate in the study. References Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996 Jan;87(1):55–8. Lete I, Häusler ,Günther, Pintiaux ,Axelle, Jamin ,Christian, Nappi ,Rossella E., Fiala ,Christian, et al. The inconvenience due to women’s monthly bleeding (ISY) survey: a study of premenstrual symptoms among 5728 women in Europe. Eur J Contracept Reprod Health Care. 2017 Sep 3;22(5):354–9. Botello-Hermosa A, González-Cano-Caballero M, Guerra-Martín MD, Navarro-Pérez CF, Arnedillo-Sánchez S. Perceptions, Beliefs, and Experiences about the Menstrual Cycle and Menstruation among Young Women: A Qualitative Approach. Healthc Basel Switz. 2024 Feb 28;12(5):560. Vitzthum VJ, Thornburg J, Spielvogel H, Deschner T. Recognizing normal reproductive biology: A comparative analysis of variability in menstrual cycle biomarkers in German and Bolivian women. Am J Hum Biol. 2021;33(5):e23663. King S. Menstrual Myth Busting [Internet]. Policy Press. Policy Press; [cited 2025 May 14]. Available from: https://policy.bristoluniversitypress.co.uk/exposing-menstrual-myths Scambler G, Scambler G. Menstrual Disorders. London: Routledge; 2003. 124 p. Muqaddas M, Youshay M. Stigma as a Barrier to Seeking Treatment for Dysmenorrhea - A Review. J Women Med Dent Coll [Internet]. 2024 Sep 30 [cited 2025 May 14];2(3). Available from: https://jwmdc.com/index.php/jwmdc/article/view/85 Åkerman E, Wängborg A, Persson M, Sörensdotter R, Klingberg-Allvin M. Navigating menstrual stigma and norms: a qualitative study on young people’s menstrual experiences and strategies for improving menstrual health. BMC Public Health. 2024 Dec 17;24(1):3401. Women in focus: understanding women as digital health consumers | Rock Health [Internet]. 2025 [cited 2025 May 16]. Available from: https://rockhealth.com/insights/women-in-focus-understanding-women-as-digital-health-consumers/ Epstein DA, Lee NB, Kang JH, Agapie E, Schroeder J, Pina LR, et al. Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools. In: Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems [Internet]. New York, NY, USA: Association for Computing Machinery; 2017 [cited 2021 Jan 1]. p. 6876–88. (CHI ’17). Available from: https://doi.org/10.1145/3025453.3025635 Levy J, Romo-Avilés N. “A good little tool to get to know yourself a bit better”: a qualitative study on users’ experiences of app-supported menstrual tracking in Europe. BMC Public Health. 2019 Sep 3;19(1):1213. Hong M, Rajaguru V, Kim K, Jang SY, Lee SG. Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study. J Med Internet Res. 2024 Oct 10;26(1):e53146. Chen CX, Shieh C, Draucker CB, Carpenter JS. Reasons women do not seek health care for dysmenorrhea. J Clin Nurs. 2018;27(1–2):e301–8. Ozeki C, Maeda E, Hiraike O, Nomura K, Osuga Y. Changes in menstrual symptoms and work productivity after checklist-based education for premenstrual syndrome: an 8-month follow-up of a single-arm study in Japan. BMC Womens Health. 2024 Apr 15;24(1):242. Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod Oxf Engl. 2012 Dec;27(12):3412–6. Santer M, Wyke S, Warner P. Women’s management of menstrual symptoms: Findings from a postal survey and qualitative interviews. Soc Sci Med. 2008 Jan 1;66(2):276–88. Pettersson A, Berterö CM. How Women with Endometriosis Experience Health Care Encounters. Womens Health Rep New Rochelle N. 2020;1(1):529–42. Hylan TR, Sundell K, Judge R. The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. J Womens Health Gend Based Med. 1999 Oct;8(8):1043–52. Peel R, Missen K, Bailey C, Florentine S. The experience of healthcare interactions for women with symptoms of abnormal menstruation: A systematic review and meta-synthesis. Patient Educ Couns. 2025 Sep 1;138:109225. Osborn E, Wittkowski A, Brooks J, Briggs PE, O’Brien PMS. Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation. BMC Womens Health. 2020 Oct 28;20(1):242. Kraemer GR, Kraemer RR. Premenstrual syndrome: diagnosis and treatment experiences. J Womens Health. 1998 Sep;7(7):893–907. Funnell EL, Martin-Key NA, Spadaro B, Bahn S. Help-seeking behaviours and experiences for mental health symptoms related to the menstrual cycle: a UK-wide exploratory survey. Npj Womens Health. 2024 Jan 23;2(1):1–11. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women’s lives: a qualitative study. BMC Womens Health. 2014 Oct 4;14:123. Chan K, Rubtsova AA, Clark CJ. Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation. BMC Womens Health. 2023 May 17;23(1):272. Zaks N, Batuure A, Lin E, Rommel AS, Reichenberg A, Grice D, et al. Association Between Mental Health and Reproductive System Disorders in Women: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023 Apr 18;6(4):e238685. Kvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L, et al. Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update. 2015;21(4):500–16. Self-care for health and well-being [Internet]. [cited 2025 Jun 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/self-care-health-interventions Song M, Kanaoka H. Effectiveness of mobile application for menstrual management of working women in Japan: randomized controlled trial and medical economic evaluation. J Med Econ. 2018 Nov;21(11):1131–8. Cunningham AC, Prentice C, Peven K, Wickham A, Bamford R, Radovic T, et al. Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial. JMIR MHealth UHealth. 2024 May 2;12(1):e54124. Hohmann-Marriott BE, Williams TA, Girling JE. The role of menstrual apps in healthcare: provider and patient perspectives. N Z Med J. 2023 Feb 17;136(1570):42–53. Additional Declarations Competing interest reported. All researchers involved in this study were employees or paid consultants of Biowink GmbH, the developers of the Clue app. Supplementary Files npjSupplementaryMaterialsMTAuseinmenstrualhealthmanagement.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 15 Apr, 2026 Reviews received at journal 19 Mar, 2026 Reviewers agreed at journal 01 Mar, 2026 Reviews received at journal 09 Dec, 2025 Reviewers agreed at journal 18 Nov, 2025 Reviewers invited by journal 08 Sep, 2025 Editor assigned by journal 23 Jul, 2025 Submission checks completed at journal 14 Jul, 2025 First submitted to journal 10 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7096664","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":515090219,"identity":"a899a041-36f4-4d64-aa7a-5342e9650b5c","order_by":0,"name":"Amanda A. Shea","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYLACHiA2YGBgfMzAYCHDwMDcQLQWZmMGBgkgm5F4LWzSRGnhn3b42YM3NQz25uzNz6oLKiR4+NkPtkl8YLCT08WhU+J2mrnhnGMMiTt7jpndnnFGgkeyJ7FNcgZDsrHZARzW3E4wk+ZhY0gwuJFgdpu3TYLH4AZjmzQPw4HEbTi0yN9O/ybN84/B3uD+82/FvP+gWv7g0WJwO8dMmreNgXHDDR4zZt4GqBYGPFoMb+eUSc7tk0jccCanWJrnGNgvzZY9Brj9Inc7fZvEm2829gbHj2/8zFNjI8fPfvjgjR8VdnI4vQ8BEhgOxqt8FIyCUTAKRgEBAACO/lT7jTcs8QAAAABJRU5ErkJggg==","orcid":"","institution":"Clue by Biowink GmbH","correspondingAuthor":true,"prefix":"","firstName":"Amanda","middleName":"A.","lastName":"Shea","suffix":""},{"id":515090220,"identity":"113be5bd-86c8-49d4-8f31-b277c7763617","order_by":1,"name":"Kirsten Weber","email":"","orcid":"","institution":"Clue by Biowink GmbH","correspondingAuthor":false,"prefix":"","firstName":"Kirsten","middleName":"","lastName":"Weber","suffix":""},{"id":515090221,"identity":"5f0394c2-832c-47be-bfb5-19c2e21c1d78","order_by":2,"name":"Cornelia Hainer","email":"","orcid":"","institution":"Clue by Biowink GmbH","correspondingAuthor":false,"prefix":"","firstName":"Cornelia","middleName":"","lastName":"Hainer","suffix":""},{"id":515090222,"identity":"f40bea59-2907-47bf-85de-68dee11e9ed1","order_by":3,"name":"Marta Gómez Vargas","email":"","orcid":"","institution":"Clue by Biowink GmbH","correspondingAuthor":false,"prefix":"","firstName":"Marta","middleName":"Gómez","lastName":"Vargas","suffix":""},{"id":515090223,"identity":"4f7124f6-0e1d-4504-bcc9-eba4409620ff","order_by":4,"name":"Virginia J. Vitzthum","email":"","orcid":"","institution":"CEMCOR, University of British Columbia","correspondingAuthor":false,"prefix":"","firstName":"Virginia","middleName":"J.","lastName":"Vitzthum","suffix":""}],"badges":[],"createdAt":"2025-07-11 01:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7096664/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7096664/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91414830,"identity":"aaba705c-34de-44eb-b9ab-4ec016ad2d01","added_by":"auto","created_at":"2025-09-16 09:10:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70334,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRespondent groups based on cycle-related worries and known or potential cycle-related health issues.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eIncludes n=2 775 with no issues, 948 with potential issues and 282 with known issues; n=7 did not answer these questions\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7096664/v1/ec960469db5fb042a73814de.jpg"},{"id":91414836,"identity":"c229cc85-b6f0-43a1-acc2-860da530afdf","added_by":"auto","created_at":"2025-09-16 09:10:50","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79813,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReported value of cycle tracking with Clue (n=7 898; respondents with worries); data in Table S7\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7096664/v1/dde7d7dbc83c88d3d35e9568.jpg"},{"id":91414834,"identity":"db1b43b1-2feb-4211-b4df-7d4bc53a41e6","added_by":"auto","created_at":"2025-09-16 09:10:50","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":190456,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReported impact of tracking with Clue on symptom assessment and management. \u003c/strong\u003eUp to n= 7 852 respondents with worries and specified a symptom of concern. Exact sample sizes vary by question; data in Table S9\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7096664/v1/23b836e4215446b7bfe9ed36.jpg"},{"id":91416223,"identity":"105cb155-21d7-4b44-b861-5ecc40ad997f","added_by":"auto","created_at":"2025-09-16 09:26:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1794383,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7096664/v1/12b4253e-4e5b-4f70-a78e-650686584f6b.pdf"},{"id":91415322,"identity":"9766d0da-7da8-4a6b-9812-bacdfc302d2f","added_by":"auto","created_at":"2025-09-16 09:18:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":507543,"visible":true,"origin":"","legend":"","description":"","filename":"npjSupplementaryMaterialsMTAuseinmenstrualhealthmanagement.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7096664/v1/fede5b598354e74b87d1d09c.pdf"}],"financialInterests":"Competing interest reported. All researchers involved in this study were employees or paid consultants of Biowink GmbH, the developers of the Clue app.","formattedTitle":"Menstrual tracking app use in menstrual health self-management: A cross-sectional survey of user concerns, goals, and strategies","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNearly all menstruating persons experience some degree of discomfort or disruption to daily life related to their menstrual cycle, whether due to bleeding, pain, fatigue, or other physical or emotional changes.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The pervasiveness of these experiences often leads to their normalization regardless of their severity, impact on quality of life, or economic cost to the individuals and the workforce.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e This conflation of \u0026lsquo;common\u0026rsquo; with \u0026lsquo;normal\u0026rsquo; can obscure the need for medical attention and support, leaving significant concerns unaddressed.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This normalization is not only medical but also cultural, shaped by long standing societal narratives that frame menstruation as private, inevitable, and something to be endured rather than treated.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Societal stigma surrounding menstruation, coupled with the historical marginalization of female health, further reinforces secrecy, self-management, and endurance without complaint or accommodations.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAn increasingly common strategy for menstrual health self-management is cycle tracking, which has been shifting from paper calendars to digital platforms.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Over the past decade, menstrual tracking apps (MTAs) have surged in popularity, with an estimated one-third of reproductive-aged women in the U.S. using such tools.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e MTAs enable users to log a range of cycle-related information from bleeding patterns and cycle-related experiences (e.g., pain, fatigue, mood changes) to broader health indicators such as sleep and libido. Many also offer predictive insights, forecasting the most likely onset of future periods and the potential recurrence of specific experiences or symptoms.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eImportantly, MTAs offer more than record-keeping. Users can actively engage with their data to anticipate recurring experiences, plan daily activities, and manage emotional and physical wellbeing.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e These tools may also help individuals reflect on the patterns and impact of their experiences, prompting healthcare conversations that might not otherwise occur.\u003c/p\u003e\u003cp\u003eHowever, despite widespread MTA use, there has been little systematic investigation into the scope and severity of users\u0026rsquo; cycle-related concerns, the extent to which disruptive symptoms are self-managed, or how MTAs contribute to daily functioning, symptom interpretation, or engagement with healthcare.\u003c/p\u003e\u003cp\u003eTo address these gaps, we surveyed users of the Clue MTA to explore their menstrual health experiences, the challenges they face, and the role of their MTA in supporting self-management and clinical engagement. By examining both the benefits and limitations of MTA use, this study aims to contribute to a deeper understanding of how digital tools can support menstrual health and inform the development of more responsive, gender-equitable healthcare systems.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDemographics and health status\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 11 910 individuals completed the survey. Respondents were 18\u0026ndash;58 years old (mean\u0026thinsp;=\u0026thinsp;30, sd\u0026thinsp;=\u0026thinsp;8) and represented 137 countries (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). A majority (67%) had a university degree or higher; 71% rated their current overall health as good or very good.\u003c/p\u003e\u003cp\u003eNearly all respondents (96%) had been using an app to track their menstrual cycles for at least a year; 48% had been using an app for \u0026ge;\u0026thinsp;5 years.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMenstrual cycle concerns\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA majority of respondents (66%, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) indicated worrying about their menstrual cycle or related symptoms. The most frequently reported reason for worry was managing daily life when experiencing symptoms (63%, Table S2). Fewer respondents were concerned about their health and/or fertility (43%) or being prepared for menstrual symptoms (36%); 34% selected more than one reason for worry.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCycle-related health issues\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf those with worries, 59% thought that they may have a cycle-related health issue and 25% had a known issue (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt least half of respondents in all groups\u0026mdash;no suspected, potential, or known cycle-related issues\u0026mdash;reported concern about managing daily life when experiencing symptoms (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This was highest among those with a known condition (73%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReported reasons for cycle-related worries and whether respondent suspected a health issue (n\u0026thinsp;=\u0026thinsp;7 898; those with worries)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eCycle-related health issues\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNone\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;1 285; 16%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ePotential\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;4 625; 59%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eKnown\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1 988; 25%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReason for worry\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eManaging daily life while having symptoms\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e666 (52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 862 (62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 451 (73%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHealth and/or fertility\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e490 (38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2022 (44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e902 (45%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBeing prepared for symptoms\u003c/b\u003e\u003csup\u003e\u003cb\u003ed\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e549 (43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1628 (35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e701 (35%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003eMore than 1 answer could be selected\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eb\u003c/sup\u003e(χ\u0026sup2;(2, n\u0026thinsp;=\u0026thinsp;7 898)\u0026thinsp;=\u0026thinsp;156.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Follow-up tests: None vs. Potential, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; None vs. Known, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Potential vs. Known, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ec\u003c/sup\u003e(χ\u0026sup2;(2, n\u0026thinsp;=\u0026thinsp;7 898)\u0026thinsp;=\u0026thinsp;17.78, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Follow-up tests: None vs. Potential, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; None vs. Known, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Potential vs. Known, p\u0026thinsp;=\u0026thinsp;0.2)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ed\u003c/sup\u003e(χ\u0026sup2;(2, n\u0026thinsp;=\u0026thinsp;7 898)\u0026thinsp;=\u0026thinsp;26.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Follow-up tests: None vs. Potential, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; None vs. Known, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Potential vs. Known, p\u0026thinsp;=\u0026thinsp;0.98)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSymptom experiences\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBody pain, emotional symptoms, and tiredness/low energy were the \u003cem\u003emost commonly\u003c/em\u003e reported symptoms of concern, each selected by over 70% of respondents with worries (Table S3). The symptoms identified as \u003cem\u003emost concerning\u003c/em\u003e were body pain (30%) and emotional symptoms (23%).\u003c/p\u003e\u003cp\u003eAmong those with worries, 47% rated their symptoms as \u0026ldquo;severe\u0026rdquo;, and 43% reported a substantial impact on daily life (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of those without worries, 15% rated their symptoms as \u0026ldquo;severe\u0026rdquo; and 10% indicated a substantial impact.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSymptom severity and impact on quality of life\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eConsidering all of your menstrual cycle symptoms together, how would you rate the overall severity of your menstrual cycle experience? (Scale from 0\u0026ndash;10, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e7 is considered severe)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eHow much impact do your menstrual symptoms have on your overall quality of life? (-2\u0026thinsp;=\u0026thinsp;no impact, 2\u0026thinsp;=\u0026thinsp;a tremendous impact)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubgroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003en(%) \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e 7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003en(%) with \u0026lsquo;a lot\u0026rsquo; or \u0026lsquo;tremendous\u0026rsquo; impact\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHas worries\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 898\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (IQR: 5\u0026ndash;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 709 (47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 898\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (IQR: -1-0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3 408 (43%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo worries\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (IQR: 3\u0026ndash;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e615 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (IQR: 0\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e391 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA majority of respondents with worries were managing their symptoms as best they could on their own (59%; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When considering diagnostic status: 67% with no suspected issues, 60% with a potential issue, and 50% with a known issue were self-managing (Table S4).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSymptom management status (n\u0026thinsp;=\u0026thinsp;7 852; those with worries and a specified symptom of concern)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhich of the following best describes where you are at in your journey with your symptom(s)?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am just dealing with my symptoms as best I can on my own\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 612 (59%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am trying to decide whether something is wrong or not\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 298 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am managing well with my current treatments or strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e680 (9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am working with a healthcare provider to try to improve my symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e619 (8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI believe something is wrong and am working with a healthcare provider to find the cause / to get a diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e439 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am waiting for surgery / to start a new treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e96 (1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI don\u0026rsquo;t think about them much (blocks other options) or no answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108 (1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOnly 9% indicated managing well with current treatments (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The most common management strategies were pain medications (63%) and symptom tracking, such as with an app (57%)(Table S5).\u003c/p\u003e\u003cp\u003e\u003cb\u003eHealthcare experiences\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAbout half (53%) of respondents with worries had spoken to an HCP; 12% had not and did not plan to (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The most common outcome was being told that their symptom was normal / not a problem (34%); 29% received a diagnosis or treatment. Similar proportions were satisfied (40%) vs dissatisfied (43%) with their healthcare experience.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHealthcare experiences of respondents with cycle-related worries\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHave you spoken to a healthcare provider (HCP) about this symptom? (n\u0026thinsp;=\u0026thinsp;7 852, those with worries and a specified symptom of concern)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 128 (53%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo and I don't plan to\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e925 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot yet, I am still deciding if it is a problem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2044 (26%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot yet, but I plan to\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e755 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhat was the result of your conversation with your healthcare provider(s)? (n\u0026thinsp;=\u0026thinsp;4 128, those with worries who had consulted an HCP)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI received a diagnosis or treatment for my symptom(s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 193 (29%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI was told it is normal / not a problem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 391 (34%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am still working with healthcare providers to figure it out\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 80 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy healthcare providers didn't know what to do / can't figure it out\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e349 (9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther - please specify:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e409 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (\u0026lt;\u0026thinsp;1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHow satisfied were you with your experience with your healthcare provider(s)? (n\u0026thinsp;=\u0026thinsp;4 128, those with worries and a specified symptom of concern)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery satisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e474 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSomewhat satisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 159 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeither satisfied nor dissatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e717 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSomewhat dissatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e985 (24%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery dissatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e788 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (\u0026lt;\u0026thinsp;1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhat were the biggest challenges in getting support with your menstrual symptom(s)? (n\u0026thinsp;=\u0026thinsp;7 852, respondents with worries and a specified symptom of concern) *multiple options could be selected except with \u0026ldquo;it was not a challenge\u0026rdquo;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare providers didn't take my concerns seriously\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 996 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare providers didn\u0026rsquo;t know what to do / couldn\u0026rsquo;t figure it out\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 372 (18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIt was difficult to arrange visits with healthcare providers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e906 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisiting healthcare providers was expensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e885 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI didn't have access to the right healthcare providers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e383 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther - please specify\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e434 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIt was not a challenge to get support (blocks other options) or no answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 594 (59%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOf those that had consulted an HCP, 59% indicated that it was \u003cem\u003enot\u003c/em\u003e a challenge to get support. However, 25% felt they had not been taken seriously and 18% said HCPs didn\u0026rsquo;t know how to help.\u003c/p\u003e\u003cp\u003e\u003cb\u003eChallenges related to menstrual health\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe most common challenges for those with worries were managing daily life with symptoms (62%), managing the stress and emotional burden of symptoms (54%), and trying to determine if there was an issue (42%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Only 6% indicated that everything felt manageable.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eBiggest challenges related to menstrual health (n\u0026thinsp;=\u0026thinsp;7 898, those with worries)\u003c/b\u003e *multiple options could be selected\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eIn general, what are your biggest challenges related to your menstrual health?\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManaging my daily life while having my symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4928 (62%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManaging the stress / emotional burden of my symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4271 (54%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrying to figure out if there is an issue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3296 (42%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrying to improve my symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3161 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGetting taken seriously by healthcare providers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2294 (29%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGetting a diagnosis for my symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1666 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGetting access to the right healthcare providers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1236 (16%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaying for healthcare / treatments related to my symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1176 (15%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManaging the logistics of healthcare (such as transportation and time for appointments)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e786 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88 (1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEverything currently feels manageable (blocks other options) or no answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e434 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMTA use\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRegarding tracking goals, 94% of those with worries wanted to record their periods and get predictions; 62% aimed to understand or identify symptom patterns, and 27% already knew their patterns and tracked to be prepared (Table S6).\u003c/p\u003e\u003cp\u003eNearly all agreed tracking helped them feel more prepared for their period (96%; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Table S7). Large majorities also reported it helped them better understand their body and cycle patterns (90%) and made them feel more \u0026ldquo;in control\u0026rdquo; of their health (72%); 64% agreed they would have more health-related stress if they did not use Clue. Responses were similar for the full cohort of respondents (with or without worries) (Table S8).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFocusing on symptom management, a majority of respondents with worries agreed that tracking helped them feel more prepared (81%) and increased their confidence in speaking with a healthcare provider (60%). Half (50%) felt tracking validated their feeling that something might be wrong, 36% said it helped them identify symptom triggers/alleviators, and 31% reported that it helped them uncover a potential health issue (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e / Table S9). Of those who saw a provider, 59% said that tracking helped them decide to initiate a conversation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOf those with cycle-related worries, 91% were satisfied with the Clue app, 7% were neutral, and 2% were dissatisfied. The proportions were similar for the full study cohort (Table S10).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRegardless of their impact, menstrual cycle-related symptoms are often trivialized, leaving many to manage their health concerns with little meaningful support. In this study, 66% of respondents expressed concern about their cycle experiences, and 94% reported ongoing challenges related to their menstrual health. While around half had consulted an HCP and nearly a third had received a diagnosis, most continued to struggle with symptom management, often relying solely on self-management strategies. MTAs were commonly used to track symptoms, identify patterns, and prepare for upcoming cycles, thereby giving users a greater sense of control over their menstrual health.\u003c/p\u003e\u003cp\u003eImportantly, many of the reported experiences were not mere inconveniences. Nearly half of those with concerns rated their symptoms as severe and significantly disruptive to daily life. Even among those without explicit concerns, more than one in six reported severe symptoms. Notably, nearly half of concerned respondents had not spoken to an HCP, and a quarter were unsure whether their symptoms warranted medical support. When asked about their biggest menstrual health challenges, over 40% indicated struggling to determine whether there was a health issue or not.\u003c/p\u003e\u003cp\u003eThese findings echo a recurring theme in the literature: considerable cycle-related physical or psychological discomfort are often perceived as \"normal\" or an unavoidable consequence of having a female body.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Internalization of this framing can make it difficult to recognize whether symptoms warrant medical attention, leading many to hesitate, second-guess themselves, or assume their experiences do not justify care. In an open response question, one respondent demonstrated this conflict, stating: “There’s nothing wrong with me, my symptoms are 100% normal and within the typical range, but it still hurts too much to go on about my day like nothing’s wrong. I feel stuck…” This dynamic has been described as a paradox or catch-22, in which the female body is viewed as inherently debilitated, yet personal accounts of pain or dysfunction are routinely minimized.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Mild discomfort may be pathologized, while debilitating symptoms are dismissed as “normal”, leaving individuals in a no-win situation. Seeking care risks embarrassment or dismissal; avoiding care contributes to continued suffering. This perception of menstrual suffering as “normal” is disempowering and is a significant contributor to diagnostic delays for conditions such as endometriosis.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAnother barrier to help-seeking is the belief, shaped by both cultural expectations and lived experience, that effective treatment is not available.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e As one respondent shared, “My symptoms profoundly affect my life, however, it has been this way my whole life. It is a given that I have to adapt or ignore my symptoms”. Another described the cost-benefit calculation many face: “The fear when something is wrong, but you don't know what it is, while knowing if you do try to see a doctor, there will be little to nothing they can do or say to make you feel better and it will all cost two weeks worth of wages.” Notably, prior research found that those with more severe symptoms are also more likely to believe no effective treatments exist.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA substantial body of research documents the difficulties many face when seeking care for menstrual health concerns, including being dismissed by clinicians, needing to continuously advocate for themselves, having to consult multiple providers, and often enduring long diagnostic delays and considerable financial burden.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e–\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e These challenges have not abated over time. In our study, only 40% of respondents who sought care were satisfied with their experience and a quarter of those that consulted an HCP said their biggest challenge was getting taken seriously. Many were told that their symptoms were “normal” or not medically concerning, leaving some feeling dismissed and unsupported. One participant captured the frustration: “[It’s] stressful because the doctors all say they don't know what is going on but also say apparently these changes are normal and expected and everyone has this, but how am I supposed to deal with this?!” Another described the burden of prolonged self-advocacy: “I had to research on my own and track my symptoms in this app. Then go to the doctor and tell them what I specifically thought was wrong with me–endometriosis. I told them of all the times I went to the doctor–over at least 10 years–with endometriosis symptoms and was told they couldn't find anything wrong with me. I finally found a female gynecologist who listened and told me that it sounded like textbook endometriosis.”\u003c/p\u003e\u003cp\u003eEven among those who received a diagnosis, many continued to struggle with unresolved symptoms. This reflects a persistent challenge: for many conditions affecting people who menstruate, diagnosis does not guarantee meaningful relief.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Individuals may encounter limited treatment options, lack of specialist knowledge, and inconsistent or outdated clinical guidelines. Individuals may also face comorbidities or a complex constellation of symptoms, making it difficult to identify approaches that fully address their needs.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Few respondents in our study reported successful symptom management with current treatments. Many were still seeking solutions or had given up entirely. One respondent wrote, “I bleed almost every two weeks to two and a half weeks. I had an ablation but it didn’t do anything to help my periods. I started birth control and it made things worse…so I quit. So I don’t do anything except track it.”\u003c/p\u003e\u003cp\u003eGiven the normalization of symptoms and the limitations of available care, it is unsurprising that many attempt to manage their health independently. Self-management, or self-care, refers to the strategies individuals use to monitor, interpret, and cope with their health outside of a clinical setting, such as tracking symptoms, adjusting daily routines, or using over-the-counter treatments.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e In this study, nearly two-thirds of those with concerns reported attempting to manage their symptoms on their own. Notably, this tendency was consistent across diagnostic groups: even among those with a known condition, half were still relying on self-management.\u003c/p\u003e\u003cp\u003eWhile self-management can be an appropriate and positive part of menstrual care, exclusive reliance on it, especially in the context of ongoing or severe symptoms, may signal broader systemic shortcomings. In such cases, self-management may be less an empowered choice than a reflection of limited options. When asked about their biggest menstrual health challenges, respondents frequently cited managing daily life and coping with the stress and emotional burden of their symptoms; fewer reported trying to alleviate their symptoms. This emphasis on adaptation over intervention may point to internalised expectations of endurance and a broader sense of resignation. One respondent shared, “I’ve had hellish periods for what feels like forever. I’ve tried talking to my GP, nurse, gynaecologist, but I feel like they think it’s nonsense…I’ve kind of given up and just try and manage as best as I can.”\u003c/p\u003e\u003cp\u003eMTAs played a meaningful role in respondents’ health management practices, with the vast majority reporting satisfaction with their app experience. Most commonly, MTAs were used to anticipate periods and better understand symptom patterns. Most respondents agreed that using an MTA increased their sense of preparedness for periods and symptoms, enhanced awareness of cycle patterns, and provided a greater sense of control over their health. These reported benefits align closely with the challenges respondents selected–often navigating daily life and managing the emotional burden of their symptoms, rather than expecting direct symptom relief.\u003c/p\u003e\u003cp\u003eKnowing what to expect can give individuals more options, whether by having menstrual products or medications ready, adjusting their schedule to accommodate anticipated challenges, or mentally bracing for difficult days. As one respondent noted, “Clue helps me make predictions for when my mental health symptoms may be worse so I can take precautions and feel able to wait for those difficult days to pass.” Another shared, “[I was] diagnosed with Primary Dysmenorrhea… I'm grateful to have the app to be able to literally plan life around period pain.”\u003c/p\u003e\u003cp\u003eAlthough MTAs are generally not designed as clinical interventions, some respondents reported symptom improvement with their use, aligning with prior research suggesting that using MTAs may help reduce symptom burden.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e However, more commonly, the act of tracking itself offered reassurance and validation, helping users to predict and contextualize their symptoms. As one respondent explained, “This app helps me keep track of the symptoms that affect my day to day and moods. It confirms what I’m going through is part of my cycle and not me failing as a human.” Another wrote, “Tracking my period with Clue makes me feel more in control of what’s happening although it can’t change my condition…\u003cem\u003e”\u003c/em\u003e\u003c/p\u003e\u003cp\u003eMTAs can also serve as valuable complements to clinical care. Many respondents reported that using Clue helped them identify health issues, seek medical attention, or ultimately receive a diagnosis. As one respondent shared, “I was misdiagnosed with IBS as a teenager and only through tracking my cycle with Clue over the past year did I realize it was likely a gynecological issue… I was diagnosed with stage IV endometriosis”. MTAs may enhance clinical interactions by helping users recognize and articulate symptom patterns that warrant further investigation, and by providing a record of their experiences to share with HCPs. Consistent with this, many respondents reported that using an MTA increased their confidence in communicating with clinicians. This aligns with prior research finding that both users and providers view MTAs as useful tools for symptom tracking and supporting clinical conversations.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis study has several limitations. As the sample comprised MTA users, findings may not be generalizable to the broader menstruating population, who may differ in symptom profiles, health concerns, prevalence of conditions, and engagement with healthcare systems. Although demographically diverse, the sample was skewed toward participants from high-income countries. Additionally, this study focused on symptom management among users with menstrual cycle concerns and did not explore other common reasons for MTA use, such as general cycle tracking to support body awareness, cycle-based lifestyle planning, or fertility-related goals.\u003c/p\u003e\u003cp\u003eIn terms of survey design, participants were asked to focus on a primary symptom of concern, which may have limited the capture of broader menstrual health experiences. While some respondents reported known or suspected cycle-related conditions, we did not ask whether their selected symptom was associated with these conditions, limiting interpretability. Lastly, as respondents were likely to be more engaged users, findings may be biased toward more favorable app experiences.\u003c/p\u003e\u003cp\u003eNotable strengths of this study include its large, international sample, offering one of the most comprehensive snapshots to date of MTA users’ menstrual health experiences and self-management practices. The findings provide valuable insight into the lived experiences of a diverse group of menstruators, while highlighting the evolving role of MTAs in supporting menstrual health, fostering body literacy and self-efficacy, and enabling more confident engagement with healthcare.\u003c/p\u003e\u003cp\u003eAt the same time, these reported benefits of MTAs must be understood within the broader context of persistent unmet need. Despite increased body awareness and the enhanced ability to prepare for symptoms, many respondents continued to experience significant symptom burden and were managing largely on their own. This reflects not only the limited availability and accessibility of effective treatments, but also enduring cultural norms that frame menstrual suffering as something to be tolerated rather than treated.\u003c/p\u003e\u003cp\u003eHCPs are well positioned to help close this gap. By partnering with patients to better understand their concerns, proactively inquiring about menstrual health, and offering timely diagnosis and care, clinicians can play a transformative role in validating experiences and improving outcomes. MTAs may serve as valuable tools in this process, supporting individuals in tracking and articulating their symptoms, and facilitating more informed, collaborative clinical conversations. Ultimately, advancing menstrual health will require coordinated efforts across clinical practice, education, research, and digital health innovation to challenge entrenched norms, reduce diagnostic delays, and ensure that individuals are not left to navigate these challenges alone.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study questionnaire (see Supplementary Materials) was developed in English and tested for comprehension and completeness via 12 interviews and 29 unmoderated tests. The final instrument comprised questions on demographic variables, self-rated overall health, menstrual cycle experiences, symptoms of concern and symptom management, personal goals for using the Clue MTA, and agree/disagree statements about the app’s usefulness. It also included an open-ended question and free-text fields where respondents could share additional information.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eQuestionnaires were distributed to Clue app users in any country who were using period tracking mode with their app language set to English. Approximately 554 000 in-app recruitment messages were sent from May 5 to May 13, 2024; 28 333 people clicked through to the survey landing page, and 12 189 respondents consented and submitted their answers. Participants who were under 18 years old or had not menstruated in the previous three months were exited from the survey. Responses from 11 910 completed questionnaires were included in the final analyses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalytical strategy\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRespondents to the question below were divided into two groups: 1) no cycle-related worries (“no worries”; response a; n = 4 005) and 2) has cycle-related worries (“those with worries”; responses b-e; n = 7 898) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eHow worried are you about your menstrual cycle or related symptoms?\u003c/b\u003e\u003c/p\u003e\u003col style=\"list-style-type: lower-alpha;\"\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eNot worried\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSlightly worried\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eModerately worried\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWorried\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eVery worried\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003eThe following question was used to further divide those with worries into three groups: 1) no issues (response a; n = 1 285), 2) potential issues (response b; n = 4 625), and 3) known issues (response c; n = 1 988)(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eWhich of the following best describes how you think about your menstrual cycle experiences and any possibly related health issues?\u003c/b\u003e You can consider things like cycle regularity, bleeding heaviness, and cycle-related symptoms like pain or mood changes.\u003c/p\u003e\u003col style=\"list-style-type: lower-alpha;\"\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI don’t think I have any cycle-related issues\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI think I may have (or am not sure if I have) a health issue that affects or is affected by my menstrual cycles\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eI have a known health issue that affects or is affected by my menstrual cycles\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003cb\u003eStatistical methods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDescriptive statistics (counts, percentages, median, and mode) were calculated for respondent groups.\u003c/p\u003e\u003cp\u003eThree Pearson’s chi-square tests were performed to evaluate the association between the three groups of cycle-related health issues and each category of reason for worrying about their menstrual cycle or related symptoms, separately, adjusting the alpha level to 0.05/3 = 0.0167 for running three separate tests.\u003c/p\u003e\u003cp\u003ePost-hoc pairwise comparisons were conducted to further explore the differences between the three groups. Another Bonferroni correction was applied to account for multiple comparisons, further adjusting the alpha level to 0.0167/ 3 = 0.0056. All analyses were performed in R using the base statistical package.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Biowink GmbH.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAAS, CH, and KW conceptualized and designed the study. AAS developed and tested the survey instrument with support from CH, KW, and MGV. Data collection was coordinated by KW, AAS, and CH. KW conducted the analyses with support from MGV and VJV. AAS and VJV drafted the manuscript with contributions from all authors. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll researchers involved in this study were employees or paid consultants of Biowink GmbH, the developers of the Clue app.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and informed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed by WCG IRB (wcgirb.com) and deemed exempt. All participants provided informed consent to participate in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996 Jan;87(1):55\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eLete I, H\u0026auml;usler ,G\u0026uuml;nther, Pintiaux ,Axelle, Jamin ,Christian, Nappi ,Rossella E., Fiala ,Christian, et al. The inconvenience due to women\u0026rsquo;s monthly bleeding (ISY) survey: a study of premenstrual symptoms among 5728 women in Europe. Eur J Contracept Reprod Health Care. 2017 Sep 3;22(5):354\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eBotello-Hermosa A, Gonz\u0026aacute;lez-Cano-Caballero M, Guerra-Mart\u0026iacute;n MD, Navarro-P\u0026eacute;rez CF, Arnedillo-S\u0026aacute;nchez S. Perceptions, Beliefs, and Experiences about the Menstrual Cycle and Menstruation among Young Women: A Qualitative Approach. Healthc Basel Switz. 2024 Feb 28;12(5):560.\u003c/li\u003e\n\u003cli\u003eVitzthum VJ, Thornburg J, Spielvogel H, Deschner T. Recognizing normal reproductive biology: A comparative analysis of variability in menstrual cycle biomarkers in German and Bolivian women. Am J Hum Biol. 2021;33(5):e23663.\u003c/li\u003e\n\u003cli\u003eKing S. Menstrual Myth Busting [Internet]. Policy Press. Policy Press; [cited 2025 May 14]. Available from: https://policy.bristoluniversitypress.co.uk/exposing-menstrual-myths\u003c/li\u003e\n\u003cli\u003eScambler G, Scambler G. Menstrual Disorders. London: Routledge; 2003. 124 p.\u003c/li\u003e\n\u003cli\u003eMuqaddas M, Youshay M. Stigma as a Barrier to Seeking Treatment for Dysmenorrhea - A Review. J Women Med Dent Coll [Internet]. 2024 Sep 30 [cited 2025 May 14];2(3). Available from: https://jwmdc.com/index.php/jwmdc/article/view/85\u003c/li\u003e\n\u003cli\u003e\u0026Aring;kerman E, W\u0026auml;ngborg A, Persson M, S\u0026ouml;rensdotter R, Klingberg-Allvin M. Navigating menstrual stigma and norms: a qualitative study on young people\u0026rsquo;s menstrual experiences and strategies for improving menstrual health. BMC Public Health. 2024 Dec 17;24(1):3401.\u003c/li\u003e\n\u003cli\u003eWomen in focus: understanding women as digital health consumers | Rock Health [Internet]. 2025 [cited 2025 May 16]. Available from: https://rockhealth.com/insights/women-in-focus-understanding-women-as-digital-health-consumers/\u003c/li\u003e\n\u003cli\u003eEpstein DA, Lee NB, Kang JH, Agapie E, Schroeder J, Pina LR, et al. Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools. In: Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems [Internet]. New York, NY, USA: Association for Computing Machinery; 2017 [cited 2021 Jan 1]. p. 6876\u0026ndash;88. (CHI \u0026rsquo;17). Available from: https://doi.org/10.1145/3025453.3025635\u003c/li\u003e\n\u003cli\u003eLevy J, Romo-Avil\u0026eacute;s N. \u0026ldquo;A good little tool to get to know yourself a bit better\u0026rdquo;: a qualitative study on users\u0026rsquo; experiences of app-supported menstrual tracking in Europe. BMC Public Health. 2019 Sep 3;19(1):1213.\u003c/li\u003e\n\u003cli\u003eHong M, Rajaguru V, Kim K, Jang SY, Lee SG. Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study. J Med Internet Res. 2024 Oct 10;26(1):e53146.\u003c/li\u003e\n\u003cli\u003eChen CX, Shieh C, Draucker CB, Carpenter JS. Reasons women do not seek health care for dysmenorrhea. J Clin Nurs. 2018;27(1\u0026ndash;2):e301\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eOzeki C, Maeda E, Hiraike O, Nomura K, Osuga Y. Changes in menstrual symptoms and work productivity after checklist-based education for premenstrual syndrome: an 8-month follow-up of a single-arm study in Japan. BMC Womens Health. 2024 Apr 15;24(1):242.\u003c/li\u003e\n\u003cli\u003eHudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod Oxf Engl. 2012 Dec;27(12):3412\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eSanter M, Wyke S, Warner P. Women\u0026rsquo;s management of menstrual symptoms: Findings from a postal survey and qualitative interviews. Soc Sci Med. 2008 Jan 1;66(2):276\u0026ndash;88.\u003c/li\u003e\n\u003cli\u003ePettersson A, Berter\u0026ouml; CM. How Women with Endometriosis Experience Health Care Encounters. Womens Health Rep New Rochelle N. 2020;1(1):529\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eHylan TR, Sundell K, Judge R. The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. J Womens Health Gend Based Med. 1999 Oct;8(8):1043\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003ePeel R, Missen K, Bailey C, Florentine S. The experience of healthcare interactions for women with symptoms of abnormal menstruation: A systematic review and meta-synthesis. Patient Educ Couns. 2025 Sep 1;138:109225.\u003c/li\u003e\n\u003cli\u003eOsborn E, Wittkowski A, Brooks J, Briggs PE, O\u0026rsquo;Brien PMS. Women\u0026rsquo;s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation. BMC Womens Health. 2020 Oct 28;20(1):242.\u003c/li\u003e\n\u003cli\u003eKraemer GR, Kraemer RR. Premenstrual syndrome: diagnosis and treatment experiences. J Womens Health. 1998 Sep;7(7):893\u0026ndash;907.\u003c/li\u003e\n\u003cli\u003eFunnell EL, Martin-Key NA, Spadaro B, Bahn S. Help-seeking behaviours and experiences for mental health symptoms related to the menstrual cycle: a UK-wide exploratory survey. Npj Womens Health. 2024 Jan 23;2(1):1\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eMoradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women\u0026rsquo;s lives: a qualitative study. BMC Womens Health. 2014 Oct 4;14:123.\u003c/li\u003e\n\u003cli\u003eChan K, Rubtsova AA, Clark CJ. Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation. BMC Womens Health. 2023 May 17;23(1):272.\u003c/li\u003e\n\u003cli\u003eZaks N, Batuure A, Lin E, Rommel AS, Reichenberg A, Grice D, et al. Association Between Mental Health and Reproductive System Disorders in Women: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023 Apr 18;6(4):e238685.\u003c/li\u003e\n\u003cli\u003eKvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L, et al. Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update. 2015;21(4):500\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eSelf-care for health and well-being [Internet]. [cited 2025 Jun 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/self-care-health-interventions\u003c/li\u003e\n\u003cli\u003eSong M, Kanaoka H. Effectiveness of mobile application for menstrual management of working women in Japan: randomized controlled trial and medical economic evaluation. J Med Econ. 2018 Nov;21(11):1131\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eCunningham AC, Prentice C, Peven K, Wickham A, Bamford R, Radovic T, et al. Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial. JMIR MHealth UHealth. 2024 May 2;12(1):e54124.\u003c/li\u003e\n\u003cli\u003eHohmann-Marriott BE, Williams TA, Girling JE. The role of menstrual apps in healthcare: provider and patient perspectives. N Z Med J. 2023 Feb 17;136(1570):42\u0026ndash;53.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [npj Women's Health](https://www.nature.com/npjwomenshealth/)","snPcode":"44294","submissionUrl":"https://submission.springernature.com/new-submission/44294/3","title":"npj Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7096664/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7096664/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDisruptive menstrual symptoms are often normalized, contributing to delayed care and reliance on self-management. Menstrual tracking apps (MTAs) are widely used to monitor cycle-related experiences, yet little is known about their role in menstrual health management or healthcare engagement. We conducted a global cross-sectional survey of Clue MTA users (n\u0026thinsp;=\u0026thinsp;11 910) assessing menstrual health experiences, healthcare interactions, and app use. Two-thirds reported being worried about their cycles or symptoms. Among those, 47% experienced severe symptoms. Just over half (53%) had spoken to a healthcare provider, but only 9% felt they were managing well with current treatments. Most (59%) were attempting to manage on their own. Users reported tracking improved feelings of period preparedness (96%), cycle awareness (90%), control over health (72%), and confidence speaking to healthcare providers (60%). MTAs may offer meaningful support for menstrual management, reflecting both their value to users and ongoing gaps in care and cultural support.\u003c/p\u003e","manuscriptTitle":"Menstrual tracking app use in menstrual health self-management: A cross-sectional survey of user concerns, goals, and strategies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 09:10:45","doi":"10.21203/rs.3.rs-7096664/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-15T23:54:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T15:45:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14230551091204641821620860014465266972","date":"2026-03-01T22:04:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T22:33:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102872149424568205636007122621140002424","date":"2025-11-18T18:21:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-08T23:43:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-23T21:20:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-14T07:15:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Women's Health","date":"2025-07-11T01:09:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [npj Women's Health](https://www.nature.com/npjwomenshealth/)","snPcode":"44294","submissionUrl":"https://submission.springernature.com/new-submission/44294/3","title":"npj Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"10527145-1bc2-4340-bfc9-f4a480ed2508","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":54709209,"name":"Health sciences/Health care"},{"id":54709210,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-04-16T00:08:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-16 09:10:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7096664","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7096664","identity":"rs-7096664","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}