The impact of dysmenorrhea on academic performance and coping strategies: lived experiences of female students in Ethiopian public universities.

Almost all participants reported experiencing varying intensity and duration of menstrual pain. Some found relief shortly after menstruation began, while others endured prolonged discomfort lasting several days. They noted that menstrual pain episodes occur frequently, with pain often radiating beyond abdominal cramping to affect the lower back and hinder mobility. In addition to pain, participants described associated symptoms such as nausea, diarrhea, headaches, and fatigue. These symptoms further impair their ability to concentrate and participate in classes, sometimes resulting in missed lectures or assignments. Students expressed frustration about how these physical challenges not only affect their health but also contribute to feelings of isolation and stress regarding their academic progress. “… Umm…the first day of my period is always the worst. I get intense cramps , and they usually last for at least three days. I can barely get out of bed during that time ” (STD 04) . “… It’s intense and unpredictable; the duration varies. At times , the pain is so severe that I end up missing classes , while other times I only have to cope with it for a few hours before it subsides. I also experience significant back pain before my period begins .” (STD 11) . “… Umm…the first day of my period is always the worst. I get intense cramps , and they usually last for at least three days. I can barely get out of bed during that time ” (STD 04) . “… It’s intense and unpredictable; the duration varies. At times , the pain is so severe that I end up missing classes , while other times I only have to cope with it for a few hours before it subsides. I also experience significant back pain before my period begins .” (STD 11) . “… It’s not just the pain in my abdomen or back. I frequently experience nausea and extreme tiredness alongside the cramps. It feels as if the discomfort affects my entire body , which makes it difficult to concentrate in class.” (STD 09) . “…The fatigue , headaches , lightheadedness , and diarrhea I experience during my period are equally as difficult as the cramps. It’s incredibly frustrating because , by the time I finally feel well enough to study , I’ve often missed important classes , assignments , or practical sessions.” (STD 02) . “… It’s not just the pain in my abdomen or back. I frequently experience nausea and extreme tiredness alongside the cramps. It feels as if the discomfort affects my entire body , which makes it difficult to concentrate in class.” (STD 09) . “…The fatigue , headaches , lightheadedness , and diarrhea I experience during my period are equally as difficult as the cramps. It’s incredibly frustrating because , by the time I finally feel well enough to study , I’ve often missed important classes , assignments , or practical sessions.” (STD 02) .

The study’s participants emphasized the significance of relational resources and support systems that female students utilize to manage dysmenorrhea. They shared the experiences that highlighted the importance of peer interactions, communication with university educators, and access to available healthcare services in addressing their menstrual health and its effects on their academic performance. They stressed that strong support networks can notably improve students’ resilience and their ability to cope during difficult periods related to dysmenorrhea during class activities and practical sessions. “…Having friends who understand my period struggles is huge. We talk about our periods all the time in the dorms , and it’s just a relief to know I’m not the only one dealing with the pain. They help me in any situation until it is gone.” ( STD 18) . “…As the saying goes , “A friend in need is a friend indeed.” I truly value the connection I share with my dorm mates and classmates. During tough times , we stand by each other , offering support in various ways , like making coffee , creating a quiet classroom environment , and even one friend of mine helped wash my legs when I experienced severe lower back pain. They give me strength. “I love you , my friends!” ( STD 11) . “…Having friends who understand my period struggles is huge. We talk about our periods all the time in the dorms , and it’s just a relief to know I’m not the only one dealing with the pain. They help me in any situation until it is gone.” ( STD 18) . “…As the saying goes , “A friend in need is a friend indeed.” I truly value the connection I share with my dorm mates and classmates. During tough times , we stand by each other , offering support in various ways , like making coffee , creating a quiet classroom environment , and even one friend of mine helped wash my legs when I experienced severe lower back pain. They give me strength. “I love you , my friends!” ( STD 11) . “…I’ve had good experiences talking to my teachers about having to miss class because of my cramps. They were really understanding and let me make up the work , which took a huge weight off my shoulders. Thank you all” (STD 03) . “…I hope that more educators realize the effect menstrual pain can have on attendance. The most challenging scenario occurs during practical attachments , such as hospital sessions , where missing even one session is not permitted , and being late can lead to punishments. Speaking up can be difficult at times , but I feel relieved when I speak to them and receive support. Some professors and instructors recognize the issue since they are also in the health field.” (STD 01) . “…I’ve had good experiences talking to my teachers about having to miss class because of my cramps. They were really understanding and let me make up the work , which took a huge weight off my shoulders. Thank you all” (STD 03) . “…I hope that more educators realize the effect menstrual pain can have on attendance. The most challenging scenario occurs during practical attachments , such as hospital sessions , where missing even one session is not permitted , and being late can lead to punishments. Speaking up can be difficult at times , but I feel relieved when I speak to them and receive support. Some professors and instructors recognize the issue since they are also in the health field.” (STD 01) .

This study utilized a phenomenological qualitative approach among female students with dysmenorrhea. Participants were chosen from Mizan Tepi University, Dilla University, Wolaita Sodo University, Hawassa University, Arba Minch University, Jinka University, Wachemo University, Bonga University, and Wolkite University. These universities offer graduate, undergraduate, and specialist programs that help students reach their intellectual, moral, and ethical potential. The universities provide regular, weekend, evening, and summer programs. Among the students, around 40% were female. The study was conducted from March 27 to April 27, 2025. This study targeted female students aged 18–49 who were enrolled in selected public institutions in southern Ethiopia. Initially, the universities were purposely selected based on feasibility considerations and the availability of students on campus during the study period. Then, the participants were recruited through convenient and snowball sampling techniques (i.e., we have used a two-step process: initially, one student with prior or current experiences of dysmenorrhea was identified conveniently, and then this participant subsequently helped recruit an additional participant with comparable experiences via a snowball sampling method). The investigation encompassed both types of menstrual pain since no diagnostic tests were conducted to confirm it. The presence of this condition among the participants was verified using both self-reported symptoms, clinical consultation from healthcare providers, and available medical records. Before selecting participants for in-depth interviews, we verified their student status through the registrar office of the university. Following the recruitment of participants, we arranged convenient times and locations for the female students to discuss their lived experiences with dysmenorrhea, the impact of these experiences on their academic endeavors, and the coping mechanisms to control the pain. Face-to-face interviews were carried out with participants from nearby universities in quiet and empty classrooms or the offices of school deans and department heads, with prior authorization obtained from them. In contrast, for participants from more distant universities, telephone interviews were conducted in carefully chosen quiet settings to ensure effective communication and accommodate the students’ schedules. Participants from the distant universities were recruited in collaboration with their respective university student deans. After we provided comprehensive information about our study and the criteria for selection of participants to the student deans, we coordinated with them to recruit participants and provide their contact information to us. Then, we conducted data collection through telephone interviews. The sample size was determined by the principle of data saturation, resulting in a total of 18 participants for this study. The study included female students aged 18 to 49 who were within the reproductive age range and had reported experiencing menstrual pain and who were required to have been enrolled in the selected universities for more than one semester and were able to provide informed consent. Exclusion criteria encompassed female students who were ill and those with known pre-existing chronic medical conditions. To gather comprehensive information about the lived experiences of female students suffering from pain during menstruation, the impact on their academic performance, and the coping mechanisms they employ, in-depth interviews were conducted using a semi-structured interview guide featuring open-ended questions. The interview guide utilized in this study was adapted from previous research conducted in diverse locations worldwide [ 2 , 8 , 9 , 11 , 16 , 21 – 23 ]. The guide was prepared in Amharic, the local language, and was used for the interviews. A flexible, open, and exploratory approach was adopted throughout the interview process to elicit rich data on this subject. The semi-structured interview guide comprised four sections. The first section included socio-demographic questions (age, university they are attending, field of study, year). The second section focused on the lived experiences of female students with dysmenorrhea (e.g., how would you describe your experience with dysmenorrhea? Can you describe the physical and emotional symptoms you encounter during your menstrual cycle? How frequently do you experience menstrual pain? How does it affect your daily life during your menstrual cycle? Have you sought any medical or therapeutic advice for managing your dysmenorrhea? The third section addressed the coping mechanisms employed by female students experiencing dysmenorrhea (e.g., What strategies do you use to cope with the pain? Are there specific home remedies, medications, or relaxation techniques that you find helpful? Who do you turn to for support when experiencing dysmenorrhea? Have you made any lifestyle changes to cope with this condition? The final section explored the impact of dysmenorrhea on the academic performance of female university students (e.g., how does dysmenorrhea influence your ability to participate in classes or complete assignments? In what ways do you think it has affected your academic performance? Do you feel that your educational institution offers adequate support for students with the same condition as you? We conducted a comprehensive evaluation of the reliability and validity of the interview guide by systematically reviewing existing literature to identify validated tools pertinent to the phenomenon under investigation and related experiences. We also engaged with subject matter experts for expert consultation and performed a pilot study with a sample of participants to verify that the tools accurately captured the intended constructs of the study. A pilot study was conducted a week prior to the main interviews to check the interview guide, evaluate trustworthiness and reliability, and evaluate elements such as the interview environment, audio recording quality, and time management. This pilot study involved one female student who experienced dysmenorrhea, and the necessary modifications were made based on the pilot study findings, addressing issues like ambiguous questions, typographical errors, and unclear terms. The adjustments aimed to enhance the probing techniques for obtaining valuable insights from participants. Interviews were carried out either face-to-face for participants from nearby universities or via telephone for those from more distant locations. All interviews were conducted in Amharic and subsequently translated into English. An audio recorder and field notes were used during the interviews, which continued until thematic saturation was reached- meaning that no new significant information or themes were identified across successive interviews. We concluded the interviews with eighteen female university students who experienced or are currently experiencing menstrual pain, and each interview lasted between 15 and 31 min. The principal researcher, who has extensive experience in conducting in-depth interviews and qualitative studies, led the sessions, while co-authors assisted by managing time, scheduling the participants, and handling the recording. In this study, data collection and analysis were conducted simultaneously. In this, a complementary approach was used, combining Colaizzi’s descriptive phenomenological framework with thematic content analysis. Initially, Colaizzi’s method was utilized to obtain a profound understanding of individual students’ narratives concerning their experiences with dysmenorrhea, its influence on their academic achievement, and their coping mechanisms. This method facilitated the extraction of detailed, subjective insights within the specific contexts of each participant’s experience. Subsequently, thematic content analysis was applied across the collected narratives to discern recurring patterns, shared challenges, and common coping strategies. The combined application of these methodologies enhanced the comprehensiveness of the study by providing both in-depth individual perspectives and overarching thematic insights into the academic and personal impacts of dysmenorrhea, as well as the adaptive strategies employed by the students. First, we utilized Colaizzi’s descriptive phenomenological framework analysis method, which uniquely includes follow-up with study participants to confirm findings and consists of seven steps. In step 1 (familiarization), we immersed ourselves in the data through repeated reading of interview transcripts to develop an in-depth understanding of female students’ lived experiences with dysmenorrhea and its influence on their academic performance, as well as the coping mechanisms they have utilized. In step 2 (identifying significant statements), we extracted and highlighted key phrases that directly relate to the impact of the disorder on study routines, emotional well-being, and coping mechanisms, capturing the core aspects of their experiences. In step 3 (Formulating meanings), we interpreted these statements to uncover underlying themes, such as physical experiences, emotional and psychological responses, sociocultural influences, personal coping strategies, utilization of medical support, social support networks, and academic engagement and performance. In step 4 (clustering themes), we organized these meanings into broader categories or themes to identify patterns across participants’ experiences. In step 5 (developing an exhaustive description), we synthesized the themes into a detailed narrative that comprehensively portrays the collective experiences of female students managing dysmenorrhea and its academic implications. In step 6 (producing the fundamental structure), we condensed this comprehensive description into a concise statement that encapsulates the essential impact of menstrual pain and associated coping mechanisms. Finally, in step 7 (seeking verification), we returned to participants and consulted some experts to validate the findings, ensuring an accurate representation of their experiences and confirming that the analysis resonates with their lived realities [ 24 ]. Initially, the recorded audio data was listened to repeatedly, and then the audio was transcribed verbatim into Amharic, the language used during the interviews. Subsequently, the transcribed texts were translated into English and converted into plain text for coding using OpenCode software for analysis. Secondly, we have used a thematic analysis, resulting in the emergence of themes and sub-themes. Finally, the identified themes and sub-themes were critically reviewed by the most experienced researchers in qualitative data analysis. The quality of the data for this study was ensured by employing Guba’s criteria for trustworthiness, with a rigorous and careful focus on the study’s credibility, transferability, dependability, and confirmability [ 25 ]. To bolster credibility, strong trust and good rapport were established with participants, and the methods of data analysis, as well as the contents of the interview guide and any issues arising during the interviews, were clarified to participants to validate the results. Detailed descriptions of the research design, data collection, and analysis processes were provided, and additionally, a comprehensive explanation of the study’s context was presented, enabling readers to make informed judgments regarding its transferability. To strengthen the dependability, carefully reviewing audio recordings of the interviews, capturing both verbal and nonverbal data, and meticulously archiving the verbatim transcriptions to facilitate cross-checking throughout the study and to maintain consistency in the interpretation was done. The researchers outlined the study’s purpose, the use of an electronic voice recorder, the study’s objectives, interview norms, time allotments, each step of data analysis, and ethical considerations for participants to ensure the confirmability of the study findings. Finally, the audio recordings against the transcribed notes were reviewed by the two most experienced qualitative researchers to validate the transcribed data for accuracy and completeness before and after translation and analysis.

In this study, a total of eighteen female students participated, comprising six third-year students, five fourth-year students, and seven fifth-year students. The ages of the participants ranged from 22 to 31 years. Additionally, the participants hailed from various colleges or schools within the selected universities for the study. The interviews were conducted in Amharic, the local language, and all participants were fluent speakers of Amharic (Table  1 ). Table 1 Socio-Demographic characteristics of the female students at selected public universities in Southern Ethiopia ( n  = 18), 2025 Participant ID Age (years) Undergraduate year College/School University STD 01 31 5th Health Sciences and Medicine Wolaita Sodo STD 02 29 3rd Law Wolaita Sodo STD 03 23 3rd Social Sciences and Humanities Wachemo STD 04 24 3rd Business and Economics Wachemo STD 05 27 4th Business and Economics Arba Minch STD 06 32 5th Agriculture Arba Minch STD 07 26 4th Natural and Computational Science Hawassa STD 08 30 5th Engineering Hawassa STD 09 22 5th Engineering Wolkite STD 10 26 3rd Health Sciences and Medicine Wolkite STD 11 24 5th Informatics Jinka STD 12 24 5th Health Sciences and Medicine Jinka STD 13 23 4th Health Sciences and Medicine Mizan Tepi STD 14 22 4th Veterinary Medicine Mizan Tepi STD 15 25 3rd Engineering Bonga STD 16 27 3rd Natural and Computational Science Bonga STD 17 24 5th Agriculture Dilla STD 18 25 4th Engineering Dilla Socio-Demographic characteristics of the female students at selected public universities in Southern Ethiopia ( n  = 18), 2025 In this study, three categories were explored: the lived experiences of dysmenorrhea, its impact on academic performance, and coping mechanisms. In these three categories, seven main themes and twenty-three subthemes were identified regarding the lived experiences of dysmenorrhea, and its impact on academic performance and coping mechanisms utilized among female students at public universities in southern Ethiopia. The main themes extracted were: physical experiences, emotional and psychological responses, socio-cultural influences, personal coping strategies, utilization of medical support, social support networks, and academic engagement and performance. The main themes and subthemes are displayed in Table  2 . Table 2 Presentation of the themes and subthemes of the lived experiences of dysmenorrhea, impact on academic performance, and coping mechanisms among female students at public universities in Southern ethiopia, 2025 Category Main Themes Sub-themes Lived Experiences of Dysmenorrhea Physical Experiences ✓ Intensity, duration, and frequency of pain (abdominal and back pain) ✓ Associated symptoms (nausea, diarrhea, headaches, fatigue) Emotional and Psychological experiences ✓ Levels of anxiety, irritability, and stress ✓ Feelings of isolation and disconnection ✓ Variations in mood and overall emotional well-being Socio-Cultural Influences ✓ Cultural attitudes and beliefs about menstruation ✓ Gender norms and societal stigma ✓ Family support dynamics and communication Impact on Academic Activities Academic Engagement and Performance ✓ Rates of absenteeism ✓ Reduced participation in classes, group activities and assignments ✓ Challenges with time management ✓ Effects on examination performance ✓ Feelings of exclusion and withdrawal Coping Mechanisms Personal coping strategies ✓ Use of home remedies (herbs, heat application, hot drinks) ✓ Engagement in physical activities and necessary rest ✓ Dietary adjustments ✓ Preference for a quiet environment Utilization of Medical Support ✓ Accessing over-the-counter medications (e.g., NSAIDS) ✓ Consulting with healthcare professionals ✓ Awareness of medical treatment options (e.g. hormonal therapies) Social Support networks ✓ Peer support and shared experiences ✓ Effective communication with university educators/instructors Presentation of the themes and subthemes of the lived experiences of dysmenorrhea, impact on academic performance, and coping mechanisms among female students at public universities in Southern ethiopia, 2025 ✓ Intensity, duration, and frequency of pain (abdominal and back pain) ✓ Associated symptoms (nausea, diarrhea, headaches, fatigue) ✓ Levels of anxiety, irritability, and stress ✓ Feelings of isolation and disconnection ✓ Variations in mood and overall emotional well-being ✓ Cultural attitudes and beliefs about menstruation ✓ Gender norms and societal stigma ✓ Family support dynamics and communication ✓ Rates of absenteeism ✓ Reduced participation in classes, group activities and assignments ✓ Challenges with time management ✓ Effects on examination performance ✓ Feelings of exclusion and withdrawal ✓ Use of home remedies (herbs, heat application, hot drinks) ✓ Engagement in physical activities and necessary rest ✓ Dietary adjustments ✓ Preference for a quiet environment ✓ Accessing over-the-counter medications (e.g., NSAIDS) ✓ Consulting with healthcare professionals ✓ Awareness of medical treatment options (e.g. hormonal therapies) ✓ Peer support and shared experiences ✓ Effective communication with university educators/instructors

This subnational study investigated the lived experiences of dysmenorrhea, its impacts on academic performance, and the coping mechanisms utilized by female students at public universities in Southern Ethiopia. The findings revealed that pain during menstruation manifested through various physical symptoms, including abdominal pain, lower back pain, nausea, diarrhea, headaches, and fatigue, as well as emotional, psychological, and socio-cultural dimensions. The study identified significant effects of dysmenorrhea on academic performance, such as increased absenteeism, diminished participation in classes and group activities, challenges in time management, negative influences on exam results, and heightened feelings of exclusion and withdrawal. The students adopted a range of coping strategies, which included personal methods, seeking medical assistance, and leveraging social support networks, such as peer interactions and communication with faculty members.

This study aimed to investigate the lived experiences of dysmenorrhea, its effects on academic performance, and the coping strategies employed by female students at public universities in Southern Ethiopia. Participants reported experiencing a range of physical symptoms associated with menstrual pain, noting that they endured severe and intense pain of varying durations and frequent episodes of abdominal and/or lower back pain, along with other related symptoms such as nausea, diarrhea, headaches, and fatigue. This is in line with the findings of research conducted in Southeast Nigeria, two studies in Egypt, and Haramaya University in Ethiopia [ 8 , 9 , 15 , 23 ]. This could be attributed to the cultural and biological factors that shape menstrual pain experiences among female students in these areas. Likewise, it might be due to similarities in the methodological approaches employed in the studies, and generally, the considerable impact of the disorder on female students is a common concern, with many women finding it challenging to manage health issues in their daily lives. Similarly, the participants reported experiencing significant emotional and psychological challenges, which included heightened anxiety, irritability, and stress. They also expressed feelings of isolation and disconnection, along with unusual fluctuations in mood and overall emotional health. This finding was supported by the studies conducted in Australia, Zambia, and Hawassa in Ethiopia [ 6 , 12 , 26 ]. This might be due to the fact that the influence of universal emotional reactions, common life experiences, and societal gender expectations can generate similar stressors across various cultures among females with dysmenorrhea. Additionally, restricted access to mental health support may intensify feelings of anxiety and irritability, while menstrual health issues can similarly impact emotional well-being in different settings. Likewise, the participants in this study explained that they experienced several social and cultural influences in their society regarding their menstrual pain. Some of these influences, as raised by the students, were negative cultural attitudes and beliefs about menstruation, strict gender norms and societal stigma, and poor family support dynamics and communication. Studies in Australia [ 26 ], Nigeria [ 5 ], and Zambia [ 6 ] supported this finding from this study. This might be due to pervasive cultural taboos surrounding menstruation, stringent gender norms, and societal stigma, all of which foster similar negative perceptions. Furthermore, a lack of education and awareness regarding menstrual health can sustain misconceptions, while ineffective family communication may lead to feelings of isolation. Sociocultural obstacles can also impede access to healthcare. Collectively, these elements create a shared experience for women dealing with menstrual pain across various cultures. In this study, participants underscored that menstrual pain had a significant impact on their academic engagement in multiple dimensions. They reported increased absenteeism from classes and practical sessions, diminished participation in lectures, group activities, and assignments, difficulties in time management, adverse effects on exam preparation and performance, as well as a wide range of feelings of exclusion and withdrawal—these were all prevalent challenges they faced due to menstrual pain during their university experience. These findings align with those of research conducted in Turkey [ 13 ], Ireland [ 18 ], Nigeria [ 1 ], South East Nigeria [ 8 ], Ghana [ 3 ], Zambia [ 6 ], Egypt [ 23 ], and Ethiopia [ 9 , 12 ] suggesting a widespread acknowledgment of the detrimental effects of pain during menstruation on academic functioning. The consistency observed across these studies may reflect shared cultural attitudes towards menstrual health, a lack of institutional support for affected students, and the universality of the condition as a significant health issue among female students across diverse global contexts. Female university students have employed different coping mechanisms in their universities to get relief from cramps and to attend to their academic efforts. In this study, the participants described that they had employed different personal coping strategies such as using home remedies, participating in sports, having adequate rest, being selective in diets, and preferring a quiet environment and dim, dark rooms. This finding is reflected in the studies conducted in Indonesia [ 2 ], Thailand [ 4 ], Ireland [ 17 ], Zambia [ 6 ], South East Nigeria [ 8 ], and three separate studies in Ghana [ 3 , 16 , 27 ]. The possible reasons for this alignment may include similarities in shared access to similar coping resources across the regions and shared cultural norms that value natural remedies and physical activity, as well as similarities in socioeconomic conditions. Additionally, the widespread dissemination of health information through social media can also facilitate the adoption of similar methods, as students share insights and recommendations for managing symptoms. Similarly, female university students reported utilizing various medical support services on campus to deal with their dysmenorrhea. They mentioned obtaining over-the-counter medications, such as non-steroidal anti-inflammatory drugs, and sought advice from healthcare professionals at university clinics. However, they indicated limited supplies of menstruation products such as pads in university clinics and a lack of awareness regarding other medical treatment options, such as hormonal therapies, and were unsure about their availability at on-campus hospitals. This finding aligns with similar studies conducted in Ghana [ 3 , 27 ] and Nigeria [ 8 ]. This indicated that female students face common challenges that compel them to rely on easily accessible over-the-counter remedies while seeking out comprehensive healthcare information. Additionally, it highlights the limited healthcare resources available on university campuses, which restricts their access to alternative reproductive health services. Ultimately, the study participants reported that social support systems, including peers and university educators, served as additional coping mechanisms during episodes of dysmenorrhea. They noted that assistance from dormmates and classmates, along with effective communication with university instructors who taught their courses, helped alleviate their discomfort during classes and practical sessions. This finding corresponds with research conducted in Ireland [ 18 ], Ghana [ 27 ], and Zambia [ 6 ]. This might be because social support is crucial in lessening the effects of menstrual pain on academic performance. Social support plays a fundamental role as a coping strategy. The shared experiences of female students in various educational contexts with peers and the communication with some educators who had a course in the class may help to address health-related challenges that impact student academic performance. This study holds considerable implications for universities, educational and health sector policymakers, and future researchers. Firstly, it assists universities in improving health services by providing targeted resources and medical support for menstrual health issues, as well as initiating awareness campaigns that encourage open dialogue among students and faculty regarding dysmenorrhea. Implementing training programs for healthcare professionals in university clinics and educators could prove advantageous in helping them identify and accommodate students facing such challenges, potentially through open communication about reproductive issues and flexible attendance policies or modified deadlines. Additionally, the findings can serve as a resource for policymakers in the education sector, aiding in the development of guidelines that prioritize menstrual health and offer support to female students suffering from menstrual pain. Moreover, this research may facilitate future studies aimed at identifying effective coping strategies that can be recommended to students. Overall, the study can contribute to fostering a more supportive academic environment, which can have a positive effect on the well-being and academic performance of female students.

Dysmenorrhea, commonly referred to as painful menstruation, is a medical condition characterized by experiencing pain during menstruation and is a prevalent issue affecting women globally, particularly among adolescents and young adults. This condition can significantly impact the quality of life, including academic performance, physical health, and emotional well-being [ 1 ]. Globally, it affects between 60% and 93% of individuals. This makes it an important public health issue, as it significantly impacts the lives of many young women who experience it [ 1 , 2 ]. Dysmenorrhea is reported to affect the majority of adolescent girls and young women at some point in their lives [ 3 ]. Dysmenorrhea can be categorized into two types based on its underlying causes: primary dysmenorrhea, which occurs in the absence of pelvic conditions, and secondary dysmenorrhea, which arises in the presence of pelvic conditions. Among younger women, endometriosis and adenomyosis are the primary contributors to secondary dysmenorrhea. It is indicated that dysmenorrhea is linked to elevated levels of prostaglandins, leading to greater uterine contractions. Specifically, the prostaglandins involved in this process are PGF2a and PGE2, which are generated during the shedding of the endometrial lining. This process increases the sensitivity of pain receptors, resulting in menstrual pain. Women experiencing dysmenorrhea tend to have higher levels of prostaglandins compared to those with regular menstrual cycles [ 3 – 6 ]. Dysmenorrhea poses significant challenges to the well-being and academic performance of university students [ 7 ]. This condition can lead to absenteeism from school and diminished participation in academic performance [ 8 ]. The most common symptoms experienced by young females with such a condition include abdominal cramps, back pain, weakness, and fatigue. Dysmenorrhea significantly affects their quality of life, leading to issues such as absenteeism, difficulty concentrating, disrupted sleep patterns, decreased appetite, and social withdrawal. As a result of the pain, these young women often develop specific coping strategies to manage their discomfort [ 3 , 9 , 10 ]. Most of the respondents reported experiencing a decreased appetite and severe pain in the pelvic and lower abdominal regions, which significantly impacted their ability to focus during lectures. The most commonly utilized nonpharmacological approach for pain relief was sleep and the application of warm objects to the abdomen [ 11 ]. The influence of menstrual pain on academic performance primarily relates to factors such as study time, focus, involvement in group activities, exam results, and attendance in classes. Additionally, it can lead to social isolation, diminished engagement in personal activities, sleep disruptions, and restrictions in daily tasks [ 12 – 14 ]. The effects of dysmenorrhea on the academic performance of female students have not been thoroughly examined. A survey conducted with female high school and university students showed that pain during menstruation was linked to increased school absenteeism and adversely affected their quality of life [ 13 ]. Young women experiencing dysmenorrhea most commonly apply the effective coping mechanisms for managing the disorder, which encompass a combination of pharmacological and non-pharmacological approaches. Over-the-counter medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, are widely recognized for their efficacy in alleviating pain and reducing inflammation. Additionally, heat therapy, such as the application of a heating pad to the lower abdomen, is frequently employed to relax muscles and ease cramping. Regular physical activity has also been shown to mitigate menstrual pain by enhancing circulation and promoting general well-being [ 11 , 15 , 16 ]. The study conducted in Ireland indicated that students are inadequately prepared to cope with dysmenorrhea. The study indicated that making a homestay a safe place was a commonly practiced coping mechanism, and social menstrual stigma and menstrual health illiteracy were the main hidden factors for this inadequate coping mechanism [ 17 ]. Overall, limited formal education on menstrual pain and prevailing negative attitudes towards menstruation create an unsupportive environment for students to learn adequate coping skills [ 17 , 18 ]. The study on nursing students who struggled with menstrual discomfort revealed that their management strategies included self-medication, the use of heat therapy, an unwillingness to seek professional medical help, and a preference for non-pharmacological approaches. These approaches included taking pain-relieving positions and consulting with other women in their family or social networks for advice [ 19 ]. Another study carried out in Turkey revealed that over half of the women utilized medication to manage dysmenorrhea, while applying heat to the abdomen was identified as the most common coping strategy among the study’s participants [ 20 ]. Ethiopia is one of the low-resource nations within which limited access to menstrual products is a serious problem, and deep-rooted cultural attitudes towards menstruation hinder open conversations about dysmenorrhea, which can impact the support systems available to students, and the prevalence of the impact of this condition on academic performance was 74.7% [ 9 ]. The study conducted on the effect of menstruation on school attendance of girls, along with water, sanitation, and hygiene services in Northwest Ethiopia, indicated that 55.5% of students missed school days due to menstrual-related factors [ 21 ]. While there have been few studies conducted in Ethiopia, to the best of our knowledge, no previous research has specifically focused on the lived experiences, their impact on academic performance, and coping mechanisms employed among female university students who struggle with dysmenorrhea. Therefore, this study will be the first of its kind in Ethiopia. Furthermore, despite our extensive search, it is evident that the majority of previous studies conducted globally on this subject have relied exclusively on quantitative research designs, which may not adequately capture the lived experiences of menstrual pain, its effects on academic performance, and coping strategies among female university students. Acknowledging this limitation, the current study employed a qualitative research design to deepen the understanding of the findings. Additionally, this research is the first of its kind to focus on three primary aims: the lived experiences of the phenomenon under study, its effects on academic performance, and the coping strategies employed among female university students. Thus, this study aimed to explore the lived experiences of female students in Ethiopian public universities regarding the impact of dysmenorrhea on their academic performance and to identify the coping strategies they employ to manage menstrual pain and its academic implications. The findings from the study are particularly significant for female university students by illuminating how menstrual discomfort impacts academic performance and helps develop a supportive educational environment. The study also informs targeted health interventions and support systems within universities, such as health education programs to equip students with effective coping strategies and improve their access to necessary medical resources.

To support female students within universities, stakeholders should undertake several proactive measures. First, universities must enhance the health services available in their clinics and hospitals by allocating essential resources and medical aid for menstrual health issues. Additionally, universities should organize awareness campaigns and provide training for faculty members to foster open discussions between students and faculty on the topic of menstrual pain and arrange flexible attendance for those who missed classes due to menstrual pain. Policymakers must also work with the universities to establish guidelines that emphasize menstrual health and aid female students experiencing the disorder. Lastly, future researchers should carry out interventional studies or projects to identify effective coping strategies and apply them to enhance the well-being of students with menstrual pain on campus. A notable strength of this study is that, to our knowledge, it represents the first qualitative research conducted in Ethiopia focusing on three primary aspects related to dysmenorrhea: the lived experiences of students, its effects on academic performance, and the coping strategies employed by female university students. Furthermore, the research included a diverse participant pool from multiple universities across southern Ethiopia. However, the study does have its limitations. Despite efforts made to enhance the transferability of the findings, the presence of inherent researcher bias must be acknowledged when interpreting and applying the results of this research.

Below is the link to the electronic supplementary material. Supplementary Material 1 Supplementary Material 1