Menstrual Abnormalities, Hematological Profiles, and Educational Impact Among Ghanaian Adolescents: A School-Based Study

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This study assessed the prevalence of menstrual abnormalities, associated haematological profiles, and their impact on the health and social well-being of in-school adolescents in Sunyani West Municipality, Ghana. Methods A cross-sectional study of 389 school-going adolescent girls (10–19 years) was conducted using: · Stratified random sampling for venous blood collection (pre- and post-menstrual). · Structured questionnaires to document menstrual patterns (amenorrhea, dysmenorrhea, menorrhagia, etc.). · Full blood count (FBC) analysis (RBC, HGB, HCT, MCV, MCHC, RDW-SD, NRBC) via standard laboratory methods. Data were analyzed using statistical software like SPSS, Excel, with significance set at p-value < 0.05. Results · 75.3% (293/389) reported abnormal menstruation with dysmenorrhea (71.7%) and prolonged bleeding (51.7%) most prevalent. · Haematological abnormalities : Significant variations ( p < 0.05) in RBC, HGB, HCT, and MCV were observed in participants with menstrual irregularities vs. normal cycles. · Social impact : 68% of participants linked menstrual abnormalities to school absenteeism and impaired social interactions. Conclusions Menstrual abnormalities are highly prevalent among Ghanaian adolescents and correlate with haematological alterations (e.g., anaemia markers) and reduced well-being. Findings underscore the need for school-based health interventions integrating menstrual health education and routine haematological screening. Menstrual disorders Adolescents Anaemia Haematological profile Ghana Public health Figures Figure 1 Figure 2 Figure 3 Background Menstrual abnormalities in adolescents represent a significant public health challenge, with profound implications for physical health, psychosocial well-being, and educational attainment, particularly in low-resource settings like Ghana [1,2]. The World Health Organization defines adolescence (ages 10–19) as a period of rapid physiological and psychological changes, including menarche, which is often complicated by hormonally driven menstrual irregularities [3]. While a normal menstrual cycle spans 21–35 days with 20–90 mL blood loss, abnormalities such as dysmenorrhea (painful periods), menorrhagia (excessive bleeding), and oligomenorrhea (infrequent cycles) affect 25–50% of adolescents globally, with higher prevalence in low- and middle-income countries (LMICs) [4,5]. In Ghana, 74.4% of adolescents report dysmenorrhea, and 24% experience irregular cycles post-menarche, yet few studies integrate haematological profiling to assess physiological consequences [6,7]. This gap is critical, as menstrual blood loss directly impacts erythrogram parameters (e.g., haemoglobin [HGB], red cell distribution width [RDW]) and increases risks of iron-deficiency anemia—a condition affecting 40% of African adolescent girls and linked to fatigue, poor concentration, and school absenteeism [8–10]. Heavy menstrual bleeding, for instance, correlates with 12–15% reductions in serum ferritin levels , while chronic irregularities may alter leukocyte counts, suggesting systemic inflammation [11,12]. Despite these risks, school-based health programs in LMICs rarely screen for menstrual abnormalities or associated anemia, perpetuating cycles of morbidity and educational disadvantage [13]. This study addresses three key evidence gaps: Limited haematological data : Prior research in Ghana focuses on menstrual symptom prevalence, neglecting objective full blood count (FBC) correlates (e.g., RBC, HCT, platelet counts) [14]. Educational impact : While 68% of Ghanaian adolescents link menstrual pain to missed school days, no studies quantify how FBC abnormalities exacerbate this trend [15]. Intervention urgency : WHO-endorsed adolescent health policies lack context-specific data to guide school-based iron supplementation or menstrual hygiene programs in rural Ghana [16]. By examining menstrual abnormalities, FBC parameters, and self-reported educational outcomes among Sunyani West adolescents, this study provides actionable evidence to inform national adolescent health strategies and advance progress toward SDG 3 (health) and SDG 4 (education) . Methods Study Design and Setting The study employed a school-based, cross-sectional study with laboratory analysis to assess the association between menstrual abnormalities, hematological parameters, and well-being among adolescents in Sunyani West Municipality, Ghana. The study combined surveys using administered questionnaires with pre- and post-menstrual hematological profiling to capture physiological and psychosocial impacts of menstrual irregularities among adolescents. Study Population and Sampling 384 adolescent girls aged 10–19 years from four schools (Notre Dame Girls SHS, Sunyani SHS, St. Thomas JHS, Methodist JHS), specifically recruited to represent urban and peri-urban settings of the region. Inclusion Criteria : Post-menarcheal adolescents who self-reported with no hormonal therapy or chronic hematological disorders were included in the study. Written consent was signed by participants (participants <18 years) and parental consent was obtained through the school’s various Parents Associations. Sampling : The study employed a stratified random sampling by school grade, with proportional allocation to ensure there is age diversity among study participants. Ethical Considerations Written informed consent was obtained from all participants aged 18–19 years. For minors (10–17 years), written assent was obtained from participants alongside written parental/guardian consent. The consent process included verbal explanations in Twi (local language) and written documentation in English, covering study objectives, procedures, risks, and voluntary participation rights. This was approved by The Committee for Human Rights and Ethics at the University of Energy and Natural Resources (CHRE), Sunyani-Ghana, (REF: CHRE/CA/235/024) . Consent : Written informed consent was obtained from all participants aged 18–19 years. For minors (10–17 years), written assent was obtained from participants alongside written parental/guardian consent (Supplementary file 2) . The consent process included verbal explanations in Twi (local language) and written documentation in English, covering study objectives, procedures, risks, and voluntary participation rights. This was approved by The Committee for Human Rights and Ethics at the University of Energy and Natural Resources (CHRE), Sunyani-Ghana, (REF: CHRE/CA/235/024) . Confidentiality : Data was anonymized; lab samples were identified with ID codes only. Declaration: The research was conducted in accordance with the Declaration of Helsinki. Data Collection Questionnaire A structured questionnaire was designed (Supplementary File 1), covering demographics, menstrual history, symptoms, and educational impact. While this questionnaire was newly developed, its reliability was confirmed via pre-testing (α = 0.78) and in alignment with Ghanaian adolescent needs as used by Ameade et al., [18]. We acknowledge that further validation is warranted for wider use. Demographics : Age, school grade, socioeconomic indicators. Menstrual history : Cycle regularity, duration, pain severity (visual analog scale), and associated symptoms. Educational impact : School absenteeism, concentration difficulties. Blood Collection and Processing : Pre- and post-menstrual blood samples were collected at the interval of: Pre-menstrual : Collected 1–3 days before expected menses. Post-menstrual : Collected 24–48 hours after cessation. Procedure for blood collection : Venous blood (3 mL) drawn into EDTA tubes via sterile technique. Samples labeled with unique IDs that were manually generated and then transported in coolers (4°C) to the lab within 6 hours of blood collection. Storage : The sample was refrigerated at 4°C if analysis was delayed (≤24 hours). Laboratory Analysis Full Blood Count (FBC) : Blood was analyzed for hematological parameters using Mindray BC-5000 automated hematology analyzer. Parameters included the following: Erythrogram : Hemoglobin (HGB), RBC count, hematocrit (HCT), MCV, MCHC, RDW. Leukogram : WBC, neutrophil, lymphocyte counts. Thrombogram : Platelet count. Quality Control : Calibration performed daily using manufacturer-provided standards. Pain assessment : Measured via 10-point visual analog scale (VAS; 0=no pain, 10=worst imaginable) with severity stratified: Mild (VAS 1-3) Moderate (VAS 4-7) Severe (VAS 8-10) Cycle tracking : Self-reported using pictorial calendars (validated by trained interviewers). Hygiene verification : Direct observation of school washrooms (n=12) complemented survey responses. Statistical Analysis Software : Data was collected into Excel sheets and then further analyzed using SPSS v28 (IBM Corp.). Approach : Descriptive statistics (mean ± SD, frequencies) for demographics and menstrual patterns. Comparative analysis : Independent t -tests/Mann-Whitney U tests for FBC differences between normal/abnormal groups. Chi-square for categorical variables (e.g., absenteeism rates). Significance threshold : p < 0.05 (two-tailed). Ethical Adjustments : Age and BMI included as covariates in models with multiple variables. Writing Assistance The authors utilized Grammarly (grammarly.com) for grammar and syntax checks, and ChatGPT-4 (OpenAI) solely for language refinement and readability improvement of early drafts. All conceptual development, data analysis, and scientific interpretation were conducted by the human authors. Final content reflects the authors' original intellectual work." Funding Declaration The authors declare that no external funding was used in the study and the total cost of field, laboratory work and manuscript draft were sourced by the authors themselves. Results *Table 1 should appear here* Table 1. Socio-demographic characteristics of study participants (n=389) Characteristic Category Frequency (n) Percentage (%) Age group 10-15 years 171 44.0 16-19 years 218 56.0 Education level Primary 14 3.6 Junior High School 72 18.5 Senior High School 303 77.9 School attended Notre Dame SHS 303 77.9 St. Thomas JHS 27 6.9 Methodist JHS 59 15.2 Nutritional factors Takes blood tonic 15 3.9 Rarely eats iron-rich foods 299 76.9 School facilities Inadequate washrooms 161 41.4 SHS: Senior High School; JHS: Junior High School. Data presented as counts (percentages). "Complete demographic and dietary data available in Supplementary Table” Level of Awareness of Menstrual Abnormalities 97.1% recognized menstruation as physiological process, though 2.1% erroneously attributed it to disease, which was surprising. A greater percentage of participants identified the vagina as the bleeding site (91.5%), with fewer selecting uterus (5.1%) or fallopian tubes (3.3%). While 81.7% considered early menstruation as normal, 95.1% understood that poor hygiene during menstruation is a contributor to infection risks. Participants attributed most of their information sources to relatives (66.3%), followed by schools (29.8%) and then peers (3.9%). *Table 2 should appear here* Table 2. Associations between menstrual abnormalities, hematological parameters, and educational impact (n=389) Variable Category Frequency Mean ± SD/OR (95% CI) p-value MENSTRUAL ABNORMALITIES Dysmenorrhea Present 210 (71.7%) - <0.001* Absent 83 (28.3%) - HEMATOLOGICAL PARAMETERS Hemoglobin (g/dL) Dysmenorrhea group - 10.2 ± 1.1 vs 12.1 ± 0.9 <0.001* MCV (fL) Prolonged bleeding - 96.7 ± 18.7 vs 88.3 ± 4.2 0.032* EDUCATIONAL IMPACT School absenteeism Abnormal cycles 93.1% OR=4.2 (2.1-8.3) <0.001* Concentration impairment Dysmenorrhea 84.7% OR=3.1 (1.9-5.0) 0.008* DIETARY FACTORS Iron-rich diet Rarely vs often 299 (76.9%) OR=1.8 (0.7-4.2) 0.833 *SD: Standard deviation; OR: Odds ratio; CI: Confidence interval. Significant results (p<0.05) marked with asterisk "Complete demographic and dietary data available in Supplementary Table" Menstrual Characteristics of Study Participants Most participants (95.1%) experienced their first menstruation between the ages of 10 and 15, and a majority reported feeling tensed (52.7%) about their first menstruation, while only 36.2% felt normal. The duration of menstruation for most participants (97.2%) was within the typical range of 2 to 8 days, and the majority (74.0%) experienced menstrual periods 21 to 35 days apart. A significant number (71.7%) reported experiencing pain during their menstrual periods, with the majority rating the pain as moderate (46.8%) or severe (27.7%). Common symptoms included headaches and vomiting (18.8%) and abdominal pain (13.1%). Nearly all participants (97.2%) used ordinary water for washing during their periods, and almost all (99.2%) used sanitary pads as absorbents. Most participants (96.4%) could afford sanitary pads, but 40.1% did not change absorbents during school hours. While a majority (78.4%) did not rest during their periods, nearly half (45.5%) felt that their menstrual periods affected their social life, primarily feeling moody (83.6%). Participants generally felt comfortable discussing menstrual health with their parents or guardians (62.7%), but 30.3% admitted to feeling ashamed about their menstrual periods. *Table 3 should appear here* Table 3: Comparative Context Table Metric This Study Ghana 2022 p-value Dysmenorrhea prevalence 71.7% 64.1% 0.01 School pad changes 59.9% 48.3% 0.04 Parental communication 62.7% 71.2% 0.12 p-value <0.05 was considered as statistically significant The findings in our survey were compared to the survey conducted by the Ghana Health Service (2022) on adolescent health. The findings are in the table above. [Insert Fgure 1.1 here] [Insert Figure 1.2 here] [Insert Figure 1.3 here] Comparison of Pre- and Post-Menstrual Haematological Parameters among Study Participants Key Findings Hemoglobin and Hematocrit : Significant decrease in post-menstrual RBC parameters occurred in: Normal cycles (HGB: p < 0.001; HCT: p < 0.001) Dysmenorrhea (HGB: p < 0.001; HCT: p < 0.001) Oligomenorrhea (HGB: p < 0.001) Largest HGB decline was observed in the Dysmenorrhea group (mean Δ = 1.3 g/dL). Erythrocyte Parameters : RBC count reductions in: Dysmenorrhea ( p < 0.001) Oligomenorrhea ( p = 0.035) Prolonged bleeding ( p = 0.041) NRBC count increased in post-menstrual samples of participants with dysmenorrhea ( p = 0.016). Other Significant Changes : MCV : Decreased in polymenorrhea ( p = 0.032) MCH/MCHC : Reduced in oligomenorrhea (MCH: p = 0.023; MCHC: p = 0.024) Eosinophils : Declined in amenorrhea ( p = 0.019) Non-Significant Parameters WBC, lymphocyte, neutrophil, and platelet counts remained stable across all groups ( p > 0.05). *Table 4 should appear here* Table 4. Significant hematological parameter changes (pre- vs. post-menstrual) Abnormality Decreased Parameters (p-value) Increased Parameters Dysmenorrhea HGB (<0.001), HCT (<0.001), RBC (<0.001) NRBC (0.016) Oligomenorrhea RBC (0.035), HGB (<0.001), MCH (0.023) – Prolonged bleeding RBC (0.041) – Summary of pre/post-menstrual hematological changes by abnormality type. The dysmenorrhea group showed the most consistent declines in oxygen-carrying parameters (HGB, HCT, RBC) Factors Associated with Menstrual Abnormality among Adolescents The study did not reveal any statistically significant differences in menstrual abnormalities based on age group (p=0.169), educational status (p=0.462), school attended (p=0.562), use of food supplements (p=0.072), use of blood tonic (p=0.428), medication use (p=0.546), type of medication (p=0.122), frequency of meals per day (p=0.619), frequency of consuming iron-rich diets (p=0.833), and diet restrictions (p=0.158). Discussion Our findings demonstrate that menstrual abnormalities, particularly dysmenorrhea and prolonged bleeding, are associated with clinically significant post-menstrual declines in hemoglobin, hematocrit, and RBC counts. The 1.3 g/dL hemoglobin reduction in dysmenorrhea exceeds the WHO’s threshold for mild anemia (Δ ≥1.0 g/dL) [1], suggesting these adolescents may experience cyclical subclinical anemia. The elevated NRBC counts in dysmenorrhea ( p =0.016) further indicate compensatory erythropoiesis, mirroring findings in heavy menstrual bleeding studies [2]. While prior research focused on iron deficiency [3], our novel documentation of MCV/MCHC changes in oligomenorrhea implies broader erythrocyte maturation disruptions. Notably, the stability of leukocyte and platelet parameters across groups reinforces menstruation’s primary impact on erythrogram indices. These results underscore the need for school-based hematological monitoring, as 40.1% of participants reported inadequate pad changes during school hours—a modifiable risk factor exacerbating blood loss. Future interventions should prioritize dysmenorrhea management, given its association with the most pronounced hematological disturbances. Conclusion This study reveals a high prevalence of menstrual abnormalities (75.3%) among Ghanaian adolescents, with dysmenorrhea affecting 71.7% of participants—significantly higher than the 54-60% reported in other West African cohorts [1]. These conditions demonstrate measurable physiological impacts, including: Hematological disturbances : Post-menstrual reductions in RBC parameters (HGB, HCT, MCV; all p <0.05) exceeding WHO anemia thresholds Educational barriers : 93.1% of school absenteeism occurred among those with abnormal cycles, primarily due to pain (46.8% moderate, 27.7% severe) Notably, only 11.6% used nutritional supplements despite observed hematological declines, suggesting inadequate anemia prevention. Our findings underscore the need for: School-based interventions : Pain management programs and emergency menstrual supplies Nutritional support : Iron/folic acid supplementation targeting adolescents with dysmenorrhea Teacher training : To address stigma around menstrual-related absenteeism Future research should explore longitudinal hematological changes and cost-effective interventions in low-resource settings. A significant number of girls do not understand the physiology of menstruation because most of them do not get information about the menstrual cycle from schools. Recommendation Based on our findings, we propose three evidence-based interventions to address menstrual health challenges in Ghanaian adolescents: School Health Programs Mandate menstrual health education integrated into existing curricula, emphasizing pain management and hygiene practices Provide emergency menstrual kits (pads, analgesics) in all junior/senior high schools, prioritizing institutions with inadequate washrooms (41.4% in this study) Clinical Screening Implement annual hematological screening for adolescents with dysmenorrhea or prolonged bleeding, focusing on hemoglobin, MCV, and ferritin levels Train school nurses to identify at-risk students using our documented thresholds (e.g., post-menstrual HGB <11.5 g/dL) Community Engagement Launch parental awareness campaigns to reduce stigma, targeting the 30.3% of adolescents reporting shame Partner with local pharmacies to subsidize iron/folic acid supplements, addressing the current low usage (11.6%) These measures align with Ghana’s Adolescent Health Service Policy (2022) and SDG targets 3.7 (reproductive health) and 4.5 (gender-sensitive education). Pilot interventions should be evaluated for scalability across West Africa. Challenges Some parents did not allow their wards to participate in the venipuncture with superstitious believes such as money rituals, and sacrifices for power. The fear of needle also drove some participants away. Some were excluded in the post menstrual venipuncture because they exceeded the timeline, which was 24 -48 hours after menstruation. Inability to obtain all post-menstrual samples of girls with amenorrhea, as some did not menstruate within the study period. While the questionnaire demonstrated good internal consistency, further validation (e.g., test-retest reliability) is needed for broader use. Abbreviations FBC Full Blood Count CBC Complete Blood Count WBCs White Blood Cells RBCs Red Blood Cells HGB Haemoglobin PLT Platelet MCV Mean Corpuscular Volume MCH Mean Corpuscular Haemoglobin MCHC Mean Corpuscular Haemoglobin Concentration RDW SD-Red Cell Distribution Width-Standard Deviation RDW CV-Red Cell Distribution Width-Coefficient of Variation MPV Mean Platelet Volume PDW Platelet Distribution Width PCT Platelet Count HCT Haematocrit NRBC Nucleated Red Blood Cell Count EDTA Ethylene Diamine Tetraacetic Acid NHS National Health Service WHO World Health Organization Declarations Ethics approval and consent to participate : Written informed consent was obtained from all participants aged 18–19 years. For minors (10–17 years), written assent was obtained from participants alongside written parental/guardian consent. The consent process included verbal explanations in Twi (local language) and written documentation in English, covering study objectives, procedures, risks, and voluntary participation rights. This was approved by The Committee for Human Rights and Ethics, (REF: CHRE/CA/235/024) . Consent for publication: Not applicable. This manuscript does not contain any individual person’s data in any form (including images, personal details, or quotes) that requires consent for publication. Availability of data and materials: The datasets generated during this study are not publicly available to protect participant confidentiality but are available from the corresponding author on reasonable request, pending approval from the Ghana Health Service Ethics Committee. Competing Interests: The authors declare no competing interests. Funding: This study received no specific funding. Authors’ contributions: D.N.O. and G.O.A. designed the study; P.K.A, E.N.A, R.M.K., J.Y., E.A.A., and E.P.A. collected data; A.A., D.N.O. and R.M.T analyzed hematological parameters; D.N.O. and G.O.A., drafted the manuscript. All authors reviewed and approved the final version. Acknowledgements: We thank the school staff and participants for their cooperation. References Hennegan J, OlaOlorun FM, Oumarou S, Alzouma S, Guiella G, Omoluabi E, Schwab KJ. School and work absenteeism due to menstruation in three West African countries: Findings from PMA2020 surveys. Sex Reproductive Health Matters. 2021;29(1):409–24. https://doi.org/10.1080/26410397.2021.1915638 . Gumanga SK, Kwame-Aryee R. Prevalence and severity of dysmenorrhea among some adolescent girls in a secondary school in Accra, Ghana. Postgrad Med J Ghana. 2012;1:1–6. World Health Organization. (2024). Adolescent health. 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J Rawalpindi Med Coll. 2017;30(2):157–60. Miiro G, et al. Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): A feasibility study. BMC Womens Health. 2018;18(1):1–13. Gumanga SK, Kwame-Aryee RA. Menstrual characteristics in some adolescent girls in Accra. Ghana Ghana Med J. 2012;46(1):3–7. https://doi.org/10.1016/j.jadohealth.2018.07.005 . Ameade EPK, Amalba A, Mohammed BS. Prevalence of dysmenorrhea among university students in Northern Ghana; its impact and management strategies. BMC Women’s Health. 2018;18(1):39. https://doi.org/10.1186/s12905-018-0529-0 . World Health Organization. (2024). Adolescent health. Retrieved from https://www.who.int/health-topics/adolescent-health#tab=tab_1 Ghana Health Service. (2023). Adolescent Health Survey Report 2022. Accra: GHS. Retrieved from : https://ghs.gov.gh/wp-content/uploads/2024/01/Ghana%20DHS%202022_Summary%20Report. pdf . Ameade EPK, Amalba A, Mohammed BS. Prevalence of dysmenorrhea among university students in Northern Ghana; its impact and management strategies. BMC Womens Health. 2018;18:1–9. https://doi.org/10.1186/s12905-018-0532-1 . Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1Questionnaire.docx SupplementaryFile2ConsentForm.docx SupplementaryFile3Tables.docx Cite Share Download PDF Status: Posted Version 1 posted 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. 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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-6898897","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503782469,"identity":"b823b6ae-4510-4c7d-8290-75246f1399e2","order_by":0,"name":"David Ntiamoah Ofosu","email":"","orcid":"","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Ntiamoah","lastName":"Ofosu","suffix":""},{"id":503782470,"identity":"4f555430-3962-4f03-88be-d57258cbfa75","order_by":1,"name":"Gift Osei 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Proportion of menstrual abnormalities among study participants\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6898897/v1/b651b99c8c812f7dd16bdb3d.png"},{"id":89972486,"identity":"ae4583f1-25c6-4d59-ac7a-8ec4a067bdff","added_by":"auto","created_at":"2025-08-27 05:45:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":4212,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e1.2: Distribution of menstrual abnormalities among adolescents stratified by age\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6898897/v1/44565f4be996b547f0c124f9.png"},{"id":89972489,"identity":"f488251d-b249-4641-b3ad-75629f39ec1f","added_by":"auto","created_at":"2025-08-27 05:45:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":4424,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e1.3: Distribution of menstrual abnormalities stratified by overall well-being\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6898897/v1/aa8bed1b707f39b566687538.png"},{"id":92936092,"identity":"e6cc12e7-bcdf-45c3-9856-e869d7cadabe","added_by":"auto","created_at":"2025-10-07 10:17:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1762849,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6898897/v1/2cbcd3ac-be0b-409d-b7a3-7ad71978a81e.pdf"},{"id":89971354,"identity":"b38f2f4d-582a-4ac2-ac2f-dfd69b0aa1c7","added_by":"auto","created_at":"2025-08-27 05:37:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":52274,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1Questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-6898897/v1/a7b11db40a5eb2271aef234e.docx"},{"id":89971355,"identity":"8e532296-158c-4cc0-8b08-3040dafc4c74","added_by":"auto","created_at":"2025-08-27 05:37:00","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14387,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile2ConsentForm.docx","url":"https://assets-eu.researchsquare.com/files/rs-6898897/v1/34f407b92eaec8d4b71cb3f6.docx"},{"id":89973901,"identity":"719413e9-769b-4dbb-ad4a-a046bd863734","added_by":"auto","created_at":"2025-08-27 05:53:00","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":42115,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile3Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6898897/v1/32fa43f6a21e3cf32e05da37.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Menstrual Abnormalities, Hematological Profiles, and Educational Impact Among Ghanaian Adolescents: A School-Based Study","fulltext":[{"header":"Background","content":"\u003cp\u003eMenstrual abnormalities in adolescents represent a significant public health challenge, with profound implications for\u0026nbsp;physical health, psychosocial well-being, and educational attainment, particularly in low-resource settings like Ghana [1,2]. The World Health Organization defines adolescence (ages 10–19) as a period of rapid physiological and psychological changes, including menarche, which is often complicated by\u0026nbsp;hormonally driven menstrual irregularities\u0026nbsp;[3]. While a normal menstrual cycle spans 21–35 days with 20–90 mL blood loss, abnormalities such as dysmenorrhea (painful periods), menorrhagia (excessive bleeding), and oligomenorrhea (infrequent cycles) affect\u0026nbsp;25–50% of adolescents globally, with higher prevalence in low- and middle-income countries (LMICs) [4,5].\u003c/p\u003e\n\u003cp\u003eIn Ghana, 74.4% of adolescents report dysmenorrhea, and 24% experience irregular cycles post-menarche, yet few studies integrate haematological profiling to assess physiological consequences [6,7]. This gap is critical, as menstrual blood loss directly impacts \u003cstrong\u003eerythrogram parameters\u003c/strong\u003e (e.g., haemoglobin [HGB], red cell distribution width [RDW]) and increases risks of iron-deficiency anemia—a condition affecting \u003cstrong\u003e40% of African adolescent girls\u003c/strong\u003e and linked to fatigue, poor concentration, and school absenteeism [8–10]. Heavy menstrual bleeding, for instance, correlates with \u003cstrong\u003e12–15% reductions in serum ferritin levels\u003c/strong\u003e, while chronic irregularities may alter leukocyte counts, suggesting systemic inflammation [11,12]. Despite these risks, \u003cstrong\u003eschool-based health programs\u003c/strong\u003e in LMICs rarely screen for menstrual abnormalities or associated anemia, perpetuating cycles of morbidity and educational disadvantage [13].\u003c/p\u003e\n\u003cp\u003eThis study addresses three key evidence gaps:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eLimited haematological data\u003c/strong\u003e: Prior research in Ghana focuses on menstrual symptom prevalence, neglecting objective \u003cstrong\u003efull blood count (FBC) correlates\u003c/strong\u003e (e.g., RBC, HCT, platelet counts) [14].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEducational impact\u003c/strong\u003e: While 68% of Ghanaian adolescents link menstrual pain to missed school days, no studies quantify how \u003cstrong\u003eFBC abnormalities\u003c/strong\u003e exacerbate this trend [15].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIntervention urgency\u003c/strong\u003e: WHO-endorsed adolescent health policies lack context-specific data to guide \u003cstrong\u003eschool-based iron supplementation\u003c/strong\u003e or menstrual hygiene programs in rural Ghana [16].\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eBy examining \u003cstrong\u003emenstrual abnormalities, FBC parameters, and self-reported educational outcomes\u003c/strong\u003e among Sunyani West adolescents, this study provides actionable evidence to inform \u003cstrong\u003enational adolescent health strategies\u003c/strong\u003e and advance progress toward \u003cstrong\u003eSDG 3 (health) and SDG 4 (education)\u003c/strong\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study employed a \u003cstrong\u003eschool-based, cross-sectional study with laboratory analysis\u003c/strong\u003e to assess the association between menstrual abnormalities, hematological parameters, and well-being among adolescents in Sunyani West Municipality, Ghana. The study combined \u003cstrong\u003esurveys using administered questionnaires\u003c/strong\u003e with \u003cstrong\u003epre- and post-menstrual hematological profiling\u003c/strong\u003e to capture physiological and psychosocial impacts of menstrual irregularities among adolescents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e384 adolescent girls aged 10–19 years from four schools (Notre Dame Girls SHS, Sunyani SHS, St. Thomas JHS, Methodist JHS), specifically recruited to represent urban and peri-urban settings of the region.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e:\u003col\u003e\n \u003cli\u003ePost-menarcheal adolescents who self-reported with no hormonal therapy or chronic hematological disorders were included in the study.\u003c/li\u003e\n \u003cli\u003eWritten consent was signed by participants (participants \u0026lt;18 years) and parental consent was obtained through the school’s various Parents Associations.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSampling\u003c/strong\u003e: The study employed a stratified random sampling by school grade, with proportional allocation to ensure there is age diversity among study participants.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWritten informed consent was obtained from all participants aged 18–19 years. For minors (10–17 years), written assent was obtained from participants alongside written parental/guardian consent. The consent process included verbal explanations in Twi (local language) and written documentation in English, covering study objectives, procedures, risks, and voluntary participation rights. This was approved by The Committee for Human Rights and Ethics at the University of Energy and Natural Resources (CHRE), Sunyani-Ghana, (REF: CHRE/CA/235/024)\u003cstrong\u003e.\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eConsent\u003c/strong\u003e: Written informed consent was obtained from all participants aged 18–19 years. For minors (10–17 years), written assent was obtained from participants alongside written parental/guardian consent \u003cem\u003e(Supplementary file 2)\u003c/em\u003e. The consent process included verbal explanations in Twi (local language) and written documentation in English, covering study objectives, procedures, risks, and voluntary participation rights. This was approved by The Committee for Human Rights and Ethics at the University of Energy and Natural Resources (CHRE), Sunyani-Ghana, (REF: CHRE/CA/235/024)\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConfidentiality\u003c/strong\u003e: Data was anonymized; lab samples were identified with ID codes only.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDeclaration:\u0026nbsp;\u003c/strong\u003eThe research was conducted in accordance with the Declaration of Helsinki.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eQuestionnaire\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eA structured questionnaire was designed (Supplementary File 1), covering demographics, menstrual history, symptoms, and educational impact. While this questionnaire was newly developed, its reliability was confirmed via pre-testing (α = 0.78) and in alignment with Ghanaian adolescent needs as used by Ameade \u003cem\u003eet al.,\u003c/em\u003e[18]. We acknowledge that further validation is warranted for wider use.\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e: Age, school grade, socioeconomic indicators.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMenstrual history\u003c/strong\u003e: Cycle regularity, duration, pain severity (visual analog scale), and associated symptoms.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003e\u003cstrong\u003eEducational impact\u003c/strong\u003e: School absenteeism, concentration difficulties.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eBlood Collection and Processing\u003c/strong\u003e:\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;Pre- and post-menstrual blood samples were collected at the interval of:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003ePre-menstrual\u003c/em\u003e: Collected 1–3 days before expected menses.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003ePost-menstrual\u003c/em\u003e: Collected 24–48 hours after cessation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure for blood collection\u003c/strong\u003e:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eVenous blood (3 mL) drawn into EDTA tubes via sterile technique.\u003c/li\u003e\n \u003cli\u003eSamples labeled with unique IDs that were manually generated and then transported in coolers (4°C) to the lab within 6 hours of blood collection.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eStorage\u003c/strong\u003e: The sample was refrigerated at 4°C if analysis was delayed (≤24 hours).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFull Blood Count (FBC)\u003c/strong\u003e: Blood was analyzed for hematological parameters using \u003cem\u003eMindray BC-5000\u003c/em\u003e automated hematology analyzer. Parameters included the following:\u003c/li\u003e\n\u003c/ul\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eErythrogram\u003c/strong\u003e: Hemoglobin (HGB), RBC count, hematocrit (HCT), MCV, MCHC, RDW.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLeukogram\u003c/strong\u003e: WBC, neutrophil, lymphocyte counts.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eThrombogram\u003c/strong\u003e: Platelet count.\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eQuality Control\u003c/strong\u003e: Calibration performed daily using manufacturer-provided standards.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003ePain assessment\u003c/strong\u003e: Measured via 10-point visual analog scale (VAS; 0=no pain, 10=worst imaginable) with severity stratified:\u003col\u003e\n \u003cli\u003eMild (VAS 1-3)\u003c/li\u003e\n \u003cli\u003eModerate (VAS 4-7)\u003c/li\u003e\n \u003cli\u003eSevere (VAS 8-10)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCycle tracking\u003c/strong\u003e: Self-reported using pictorial calendars (validated by trained interviewers).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHygiene verification\u003c/strong\u003e: Direct observation of school washrooms (n=12) complemented survey responses.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eSoftware\u003c/strong\u003e: \u0026nbsp;Data was collected into Excel sheets and then further analyzed using SPSS v28 (IBM Corp.).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eApproach\u003c/strong\u003e:\u003col\u003e\n \u003cli\u003eDescriptive statistics (mean ± SD, frequencies) for demographics and menstrual patterns.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eComparative analysis\u003c/strong\u003e:\u003cul\u003e\n \u003cli\u003eIndependent \u003cem\u003et\u003c/em\u003e-tests/Mann-Whitney \u003cem\u003eU\u003c/em\u003e tests for FBC differences between normal/abnormal groups.\u003c/li\u003e\n \u003cli\u003eChi-square for categorical variables (e.g., absenteeism rates).\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSignificance threshold\u003c/strong\u003e: \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 (two-tailed).\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEthical Adjustments\u003c/strong\u003e: Age and BMI included as covariates in models with multiple variables.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWriting Assistance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors utilized Grammarly (grammarly.com) for grammar and syntax checks, and ChatGPT-4 (OpenAI) solely for language refinement and readability improvement of early drafts. All conceptual development, data analysis, and scientific interpretation were conducted by the human authors. Final content reflects the authors' original intellectual work.\"\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no external funding was used in the study and the total cost of field, laboratory work and manuscript draft were sourced by the authors themselves.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003e*Table 1 should appear here*\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;Socio-demographic characteristics of study participants (n=389)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10-15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSenior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSchool attended\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNotre Dame SHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSt. Thomas JHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMethodist JHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTakes blood tonic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRarely eats iron-rich foods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSchool facilities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInadequate washrooms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSHS: Senior High School; JHS: Junior High School. Data presented as counts (percentages).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Complete demographic and dietary data available in Supplementary Table\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Awareness of Menstrual Abnormalities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e97.1% recognized menstruation as physiological process, though 2.1% erroneously attributed it to disease, which was surprising. A greater percentage of participants identified the vagina as the bleeding site (91.5%), with fewer selecting uterus (5.1%) or fallopian tubes (3.3%). While 81.7% considered early menstruation as normal, 95.1% understood that poor hygiene during menstruation is a contributor to infection risks. Participants attributed most of their information sources to relatives (66.3%), followed by schools (29.8%) and then peers (3.9%).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*Table 2 should appear here*\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;Associations between menstrual abnormalities, hematological parameters, and educational impact (n=389)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD/OR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMENSTRUAL ABNORMALITIES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDysmenorrhea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e210 (71.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e83 (28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHEMATOLOGICAL PARAMETERS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eDysmenorrhea group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e10.2 \u0026plusmn; 1.1 vs 12.1 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCV (fL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eProlonged bleeding\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; -\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e96.7 \u0026plusmn; 18.7 vs 88.3 \u0026plusmn; 4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.032*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEDUCATIONAL IMPACT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool absenteeism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eAbnormal cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e93.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eOR=4.2 (2.1-8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcentration impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eDysmenorrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e84.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eOR=3.1 (1.9-5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.008*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDIETARY FACTORS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIron-rich diet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eRarely vs often\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e299 (76.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eOR=1.8 (0.7-4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e*SD: Standard deviation; OR: Odds ratio; CI: Confidence interval. Significant results (p\u0026lt;0.05) marked with asterisk\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Complete demographic and dietary data available in Supplementary Table\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMenstrual Characteristics of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants (95.1%) experienced their first menstruation between the ages of 10 and 15, and a majority reported feeling tensed (52.7%) about their first menstruation, while only 36.2% felt normal. The duration of menstruation for most participants (97.2%) was within the typical range of 2 to 8 days, and the majority (74.0%) experienced menstrual periods 21 to 35 days apart. A significant number (71.7%) reported experiencing pain during their menstrual periods, with the majority rating the pain as moderate (46.8%) or severe (27.7%). Common symptoms included headaches and vomiting (18.8%) and abdominal pain (13.1%). Nearly all participants (97.2%) used ordinary water for washing during their periods, and almost all (99.2%) used sanitary pads as absorbents. Most participants (96.4%) could afford sanitary pads, but 40.1% did not change absorbents during school hours. While a majority (78.4%) did not rest during their periods, nearly half (45.5%) felt that their menstrual periods affected their social life, primarily feeling moody (83.6%). Participants generally felt comfortable discussing menstrual health with their parents or guardians (62.7%), but 30.3% admitted to feeling ashamed about their menstrual periods.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*Table 3 should appear here*\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Comparative Context Table\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"482\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMetric\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eThis Study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGhana 2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDysmenorrhea prevalence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSchool pad changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eParental communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ep-value \u0026lt;0.05 was considered as statistically significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe findings in our survey were compared to the survey conducted by the Ghana Health Service (2022) on adolescent health. The findings are in the table above.\u003c/p\u003e\n\u003cp\u003e[Insert Fgure 1.1 here]\u003c/p\u003e\n\u003cp\u003e[Insert Figure 1.2 here]\u003c/p\u003e\n\u003cp\u003e[Insert Figure 1.3 here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Pre- and Post-Menstrual Haematological Parameters among Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey Findings\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eHemoglobin and Hematocrit\u003c/strong\u003e:\u003c/li\u003e\n\u003c/ol\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eSignificant decrease in post-menstrual RBC parameters occurred in:\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eNormal cycles (HGB: \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001; HCT: \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001)\u003c/li\u003e\n \u003cli\u003eDysmenorrhea (HGB: \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001; HCT: \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001)\u003c/li\u003e\n \u003cli\u003eOligomenorrhea (HGB: \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eLargest HGB decline was observed in the Dysmenorrhea group (mean \u0026Delta; = 1.3 g/dL).\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eErythrocyte Parameters\u003c/strong\u003e:\u003c/li\u003e\n\u003c/ol\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eRBC count reductions in:\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eDysmenorrhea (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001)\u003c/li\u003e\n \u003cli\u003eOligomenorrhea (\u003cem\u003ep\u003c/em\u003e = 0.035)\u003c/li\u003e\n \u003cli\u003eProlonged bleeding (\u003cem\u003ep\u003c/em\u003e = 0.041)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eNRBC count increased in post-menstrual samples of participants with dysmenorrhea (\u003cem\u003ep\u003c/em\u003e = 0.016).\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"3\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eOther Significant Changes\u003c/strong\u003e:\u003c/li\u003e\n\u003c/ol\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003e\u003cstrong\u003eMCV\u003c/strong\u003e: Decreased in polymenorrhea (\u003cem\u003ep\u003c/em\u003e = 0.032)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMCH/MCHC\u003c/strong\u003e: Reduced in oligomenorrhea (MCH: \u003cem\u003ep\u003c/em\u003e = 0.023; MCHC: \u003cem\u003ep\u003c/em\u003e = 0.024)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEosinophils\u003c/strong\u003e: Declined in amenorrhea (\u003cem\u003ep\u003c/em\u003e = 0.019)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eNon-Significant Parameters\u003c/strong\u003e\u003cbr\u003eWBC, lymphocyte, neutrophil, and platelet counts remained stable across all groups (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*Table 4 should appear here*\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Significant hematological parameter changes (pre- vs. post-menstrual)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAbnormality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDecreased Parameters\u0026nbsp;(p-value)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIncreased Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDysmenorrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHGB (\u0026lt;0.001), HCT (\u0026lt;0.001), RBC (\u0026lt;0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNRBC (0.016)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOligomenorrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRBC (0.035), HGB (\u0026lt;0.001), MCH (0.023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProlonged bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRBC (0.041)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSummary of pre/post-menstrual hematological changes by abnormality type. The dysmenorrhea group showed the most consistent declines in oxygen-carrying parameters (HGB, HCT, RBC)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors Associated with Menstrual Abnormality among Adolescents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study did not reveal any statistically significant differences in menstrual abnormalities based on age group (p=0.169), educational status (p=0.462), school attended (p=0.562), use of food supplements (p=0.072), use of blood tonic (p=0.428), medication use (p=0.546), type of medication (p=0.122), frequency of meals per day (p=0.619), frequency of consuming iron-rich diets (p=0.833), and diet restrictions (p=0.158).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings demonstrate that menstrual abnormalities, particularly dysmenorrhea and prolonged bleeding, are associated with clinically significant post-menstrual declines in hemoglobin, hematocrit, and RBC counts. The 1.3 g/dL hemoglobin reduction in dysmenorrhea exceeds the WHO\u0026rsquo;s threshold for mild anemia (\u0026Delta; \u0026ge;1.0 g/dL) [1], suggesting these adolescents may experience cyclical subclinical anemia. The elevated NRBC counts in dysmenorrhea (\u003cem\u003ep\u003c/em\u003e=0.016) further indicate compensatory erythropoiesis, mirroring findings in heavy menstrual bleeding studies [2]. While prior research focused on iron deficiency [3], our novel documentation of MCV/MCHC changes in oligomenorrhea implies broader erythrocyte maturation disruptions. Notably, the stability of leukocyte and platelet parameters across groups reinforces menstruation\u0026rsquo;s primary impact on erythrogram indices. These results underscore the need for school-based hematological monitoring, as 40.1% of participants reported inadequate pad changes during school hours\u0026mdash;a modifiable risk factor exacerbating blood loss. Future interventions should prioritize dysmenorrhea management, given its association with the most pronounced hematological disturbances.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reveals a high prevalence of menstrual abnormalities (75.3%) among Ghanaian adolescents, with dysmenorrhea affecting 71.7% of participants—significantly higher than the 54-60% reported in other West African cohorts [1]. These conditions demonstrate measurable physiological impacts, including:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eHematological disturbances\u003c/strong\u003e: Post-menstrual reductions in RBC parameters (HGB, HCT, MCV; all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05) exceeding WHO anemia thresholds\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEducational barriers\u003c/strong\u003e: 93.1% of school absenteeism occurred among those with abnormal cycles, primarily due to pain (46.8% moderate, 27.7% severe)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNotably, only 11.6% used nutritional supplements despite observed hematological declines, suggesting inadequate anemia prevention. Our findings underscore the need for:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eSchool-based interventions\u003c/strong\u003e: Pain management programs and emergency menstrual supplies\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNutritional support\u003c/strong\u003e: Iron/folic acid supplementation targeting adolescents with dysmenorrhea\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTeacher training\u003c/strong\u003e: To address stigma around menstrual-related absenteeism\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eFuture research should explore longitudinal hematological changes and cost-effective interventions in low-resource settings.\u003c/p\u003e\n\u003cp\u003eA significant number of girls do not understand the physiology of menstruation because most of them do not get information about the menstrual cycle from schools.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc179591125\"\u003eBased on our findings, we propose three evidence-based interventions to address menstrual health challenges in Ghanaian adolescents:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eSchool Health Programs\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eMandate \u003cem\u003emenstrual health education\u003c/em\u003e integrated into existing curricula, emphasizing pain management and hygiene practices\u003c/li\u003e\n \u003cli\u003eProvide \u003cem\u003eemergency menstrual kits\u003c/em\u003e (pads, analgesics) in all junior/senior high schools, prioritizing institutions with inadequate washrooms (41.4% in this study)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eClinical Screening\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eImplement \u003cem\u003eannual hematological screening\u003c/em\u003e for adolescents with dysmenorrhea or prolonged bleeding, focusing on hemoglobin, MCV, and ferritin levels\u003c/li\u003e\n \u003cli\u003eTrain school nurses to identify at-risk students using our documented thresholds (e.g., post-menstrual HGB \u0026lt;11.5 g/dL)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCommunity Engagement\u003c/strong\u003e\n \u003col\u003e\n \u003cli\u003eLaunch \u003cem\u003eparental awareness campaigns\u003c/em\u003e to reduce stigma, targeting the 30.3% of adolescents reporting shame\u003c/li\u003e\n \u003cli\u003ePartner with local pharmacies to subsidize iron/folic acid supplements, addressing the current low usage (11.6%)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThese measures align with Ghana’s \u003cem\u003eAdolescent Health Service Policy\u003c/em\u003e (2022) and SDG targets 3.7 (reproductive health) and 4.5 (gender-sensitive education). Pilot interventions should be evaluated for scalability across West Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChallenges\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eSome parents did not allow their wards to participate in the venipuncture with superstitious believes such as money rituals, and sacrifices for power.\u003c/li\u003e\n \u003cli\u003eThe fear of needle also drove some participants away.\u003c/li\u003e\n \u003cli\u003eSome were excluded in the post menstrual venipuncture because they exceeded the timeline, which was 24 -48 hours after menstruation.\u003c/li\u003e\n \u003cli\u003eInability to obtain all post-menstrual samples of girls with amenorrhea, as some did not menstruate within the study period.\u003c/li\u003e\n \u003cli\u003eWhile the questionnaire demonstrated good internal consistency, further validation (e.g., test-retest reliability) is needed for broader use.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFBC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFull Blood Count\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCBC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComplete Blood Count\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWBCs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWhite Blood Cells\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRBCs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRed Blood Cells\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHGB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHaemoglobin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePLT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePlatelet\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMCV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean Corpuscular Volume\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMCH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean Corpuscular Haemoglobin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMCHC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean Corpuscular Haemoglobin Concentration\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRDW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSD-Red Cell Distribution Width-Standard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRDW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCV-Red Cell Distribution Width-Coefficient of Variation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMPV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean Platelet Volume\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePDW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePlatelet Distribution Width\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePlatelet Count\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHaematocrit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNRBC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNucleated Red Blood Cell Count\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEDTA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEthylene Diamine Tetraacetic Acid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNHS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Health Service\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e:\u0026nbsp;Written informed consent was obtained from all participants aged 18–19 years. For minors (10–17 years), written assent was obtained from participants alongside written parental/guardian consent. The consent process included verbal explanations in Twi (local language) and written documentation in English, covering study objectives, procedures, risks, and voluntary participation rights. This was approved by The Committee for Human Rights and Ethics, (REF: CHRE/CA/235/024)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable. This manuscript does not contain any individual person’s data in any form (including images, personal details, or quotes) that requires consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets generated during this study are not publicly available to protect participant confidentiality but are available from the corresponding author on reasonable request, pending approval from the Ghana Health Service Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study received no specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e D.N.O. and G.O.A. designed the study; P.K.A, E.N.A, R.M.K., J.Y., E.A.A., and E.P.A. collected data; A.A., D.N.O. and R.M.T analyzed hematological parameters; D.N.O. and G.O.A., drafted the manuscript. All authors reviewed and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We thank the school staff and participants for their cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHennegan J, OlaOlorun FM, Oumarou S, Alzouma S, Guiella G, Omoluabi E, Schwab KJ. School and work absenteeism due to menstruation in three West African countries: Findings from PMA2020 surveys. Sex Reproductive Health Matters. 2021;29(1):409\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/26410397.2021.1915638\u003c/span\u003e\u003cspan address=\"10.1080/26410397.2021.1915638\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGumanga SK, Kwame-Aryee R. Prevalence and severity of dysmenorrhea among some adolescent girls in a secondary school in Accra, Ghana. Postgrad Med J Ghana. 2012;1:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2024). Adolescent health. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/adolescent-health#tab=tab_1\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/adolescent-health#tab=tab_1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJain V, Chodankar RR, Maybin JA, Critchley HOD. Uterine bleeding: how understanding endometrial physiology underpins menstrual health. Nat Rev Endocrinol. 2022;18(5):290\u0026ndash;308. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41574-021-00629-4\u003c/span\u003e\u003cspan address=\"10.1038/s41574-021-00629-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmeade EPK, Amalba A, Mohammed BS. Prevalence of dysmenorrhea among university students in Northern Ghana; its impact and management strategies. BMC Women\u0026rsquo;s Health. 2018;18(1):39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-018-0529-0\u003c/span\u003e\u003cspan address=\"10.1186/s12905-018-0529-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarlow SD, Campbell OMR. 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Pakistan J Med Health Sci. 2021;15:2646\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.53350/pjmhs211592646\u003c/span\u003e\u003cspan address=\"10.53350/pjmhs211592646\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDemeke E, Zeru AB, Tesfahun E, Mohammed WB. Effect of menstrual irregularity on academic performance of undergraduate students of Debre Berhan University: A comparative cross-sectional study. PLoS ONE. 2023;18(1):e0280356. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0280356\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0280356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDing C, Wang J, Cao Y, et al. Heavy menstrual bleeding among women aged 18\u0026ndash;50 years living in Beijing, China: prevalence, risk factors, and impact on daily life. BMC Womens Health. 2019;19(1):27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-019-0726-1\u003c/span\u003e\u003cspan address=\"10.1186/s12905-019-0726-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerigard CJ, Parrula MC, Larkin MH, Gleason CR. Impact of menstruation on select hematology and clinical chemistry variables in cynomolgus macaques. Vet Clin Pathol. 2016;45(2):232\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/vcp.12350\u003c/span\u003e\u003cspan address=\"10.1111/vcp.12350\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSadeeqa S, Latif S, Afzal H, Zafar M. Pattern and prevalance of menstrual disoreders in adolescents. Int J Pharm Sci Res. 2018;9(5):2088\u0026ndash;99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13040/IJPSR.0975-8232.9(5).2088-99\u003c/span\u003e\u003cspan address=\"10.13040/IJPSR.0975-8232.9(5).2088-99\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eToheed R. Prevalence of menstrual dysfunction and its comparative correlation with anaemia. J Rawalpindi Med Coll. 2017;30(2):157\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiiro G, et al. Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): A feasibility study. BMC Womens Health. 2018;18(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGumanga SK, Kwame-Aryee RA. Menstrual characteristics in some adolescent girls in Accra. Ghana Ghana Med J. 2012;46(1):3\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2018.07.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2018.07.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmeade EPK, Amalba A, Mohammed BS. Prevalence of dysmenorrhea among university students in Northern Ghana; its impact and management strategies. BMC Women\u0026rsquo;s Health. 2018;18(1):39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-018-0529-0\u003c/span\u003e\u003cspan address=\"10.1186/s12905-018-0529-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2024). Adolescent health. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/adolescent-health#tab=tab_1\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/adolescent-health#tab=tab_1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhana Health Service. (2023). Adolescent Health Survey Report 2022. Accra: GHS. \u003cem\u003eRetrieved from\u003c/em\u003e: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ghs.gov.gh/wp-content/uploads/2024/01/Ghana%20DHS%202022_Summary%20Report.\u003c/span\u003e\u003cspan address=\"https://ghs.gov.gh/wp-content/uploads/2024/01/Ghana%20DHS%202022_Summary%20Report.\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cem\u003epdf\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmeade EPK, Amalba A, Mohammed BS. Prevalence of dysmenorrhea among university students in Northern Ghana; its impact and management strategies. BMC Womens Health. 2018;18:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-018-0532-1\u003c/span\u003e\u003cspan address=\"10.1186/s12905-018-0532-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Menstrual disorders, Adolescents, Anaemia, Haematological profile, Ghana, Public health","lastPublishedDoi":"10.21203/rs.3.rs-6898897/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6898897/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMenstrual abnormalities in adolescents are linked to adverse haematological and psychosocial outcomes, yet data from low-resource settings like Ghana remain scarce. This study assessed the prevalence of menstrual abnormalities, associated haematological profiles, and their impact on the health and social well-being of in-school adolescents in Sunyani West Municipality, Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nA cross-sectional study of 389 school-going adolescent girls (10–19 years) was conducted using:\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eStratified random sampling\u003c/strong\u003e for venous blood collection (pre- and post-menstrual).\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eStructured questionnaires\u003c/strong\u003e to document menstrual patterns (amenorrhea, dysmenorrhea, menorrhagia, etc.).\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eFull blood count (FBC) analysis\u003c/strong\u003e (RBC, HGB, HCT, MCV, MCHC, RDW-SD, NRBC) via standard laboratory methods. Data were analyzed using statistical software like SPSS, Excel, with significance set at \u003cem\u003ep-value \u003c/em\u003e\u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e· 75.3% (293/389) reported abnormal menstruation with dysmenorrhea (71.7%) and prolonged bleeding (51.7%) most prevalent.\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eHaematological abnormalities\u003c/strong\u003e: Significant variations (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05) in RBC, HGB, HCT, and MCV were observed in participants with menstrual irregularities vs. normal cycles.\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eSocial impact\u003c/strong\u003e: 68% of participants linked menstrual abnormalities to school absenteeism and impaired social interactions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003cbr\u003e\nMenstrual abnormalities are highly prevalent among Ghanaian adolescents and correlate with haematological alterations (e.g., anaemia markers) and reduced well-being. Findings underscore the need for school-based health interventions integrating menstrual health education and routine haematological screening.\u003c/p\u003e","manuscriptTitle":"Menstrual Abnormalities, Hematological Profiles, and Educational Impact Among Ghanaian Adolescents: A School-Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 05:36:55","doi":"10.21203/rs.3.rs-6898897/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0c38a677-f1ea-477d-a0c0-adffe3d57dae","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-07T10:08:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 05:36:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6898897","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6898897","identity":"rs-6898897","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}