Prevalence and Associated Factors of Menstrual Irregularities Among Reproductive-age Women Attending Kaah Hospital, Hargeisa, Somaliland: A Cross-sectional Study

Prevalence and Associated Factors of Menstrual Irregularities Among Reproductive-age Women Attending Kaah Hospital, Hargeisa, Somaliland: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Associated Factors of Menstrual Irregularities Among Reproductive-age Women Attending Kaah Hospital, Hargeisa, Somaliland: A Cross-sectional Study Ramla Adam, Abdiwahab Hassan, Peiter Gideon, Abdirasaq Ismail This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8436991/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: Menstrual irregularities defines as cycles shorter than 21 days, longer than 35 days, or varying more than 7 days, impacting 5-30% of reproductive-age women globally. In Somaliland, sociocultural taboos, restricted access to sanitary products, and inadequate health infrastructure worsen underreporting and unmet needs. This study determined prevalence and the characteristics of irregular menstruation among reproductive women who visit KAAH Hospital, Hargeisa. Methods: A cross-sectional hospital-based study design enrolled 288 women aged 15-49 years from March-May 2025, via convenience sampling. A standardized questionnaire captured sociodemographic, menstrual history, lifestyle, psychosocial measures (Perceived Stress Scale, Generalized Anxiety Disorder-7), and medical history (PCOS, thyroid). Hormonal assays (prolactin, TSH, LH, and FSH) were examined for possible instances. Bivariate analysis (chi-square tests) identified variables associated with irregular menstruation at a significance level of p < 0.05. Results: The frequency of irregular menstruation was 85.76%. Age (peak 25–29 years; p <0.001), income <$100 ( p <0.001), hormonal imbalances (e.g., 24.61% low LH; p <0.001), stress ( p =0.039), anxiety ( p =0.018), an unhealthy diet (66.26%; p <0.001), and less than seven hours of sleep per night (71.95%; p <0.001). Low gonadotropins and thyroid problems (18.46% elevated TSH) suggested ovarian disturbances, maybe subclinical PCOS. Conclusion: In Somaliland, high incidence indicates the need for urgent integrated screening for hormonal, psychosocial, and lifestyle risks. Education, nutrition, and FGM/C mitigation are SDG 3/5-aligned treatments that could promote reproductive equity by preventing infertility, metabolic risks, and inequities. Menstrual irregularities reproductive-age women Somaliland Associated factors Cross-sectional study BACKGROUND Menstruation is a cyclic physiological process and natural part of a woman’s life characterized by the flow of blood and endometrium from the uterine cavity. Menstrual cycle (counting from the first day of one menstrual period to the first day of the next cycle) is 21 to 35 days and lasts from 3 to 7 days duration with a volume of blood loss of 5-80 ml, this process serves as a sensitive barometer of endocrine equilibrium and overall well-being [1,2]. Process of menstruation is tightly controlled by the hypothalamus, pituitary gland, ovaries (estrogen and progesterone), and uterus endometrium. The menstrual cycle is divided into follicular and luteal phases, separated by ovulation, and regularity and length of cycles are considered as markers of endocrine function and reproductive health. The rigidity of this regulation makes menstruation highly sensitive to internal as well as external stressors, either physical, psychological, or social [3,4]. Menstrual disorders—defined as cycles shorter than 21 days, longer than 35 days, or with variations exceeding 7 days—include disruption of menstrual patterns, ovarian dysfunction and menstrual pain, impacting 5–30% of women worldwide who are in reproductive age [4,5]. Menstrual irregularity refers to any kind of changes occurring irregularity of onset, frequency of onset, duration of flow, and volume, such as irregular cycle length, anovulatory cycles, and luteal phase defects. It is most prevalent in the 21-25 years age group (85%) and constitute a leading impetus for gynecological consultations worldwide. Menstrual disorders are affecting the menstrual cycle, such as abnormal uterine bleeding (AUB), dysmenorrhea, menorrhagia, metrorrhagia, oligomenorrhea, amenorrhea, and polymenorrhagia [2,6]. Menstrual-related problems affect an estimated 500 million people worldwide, with prevalence rates ranging from 23-76.6%. Period irregularities were reported by 12.5% to 55% of teenage girls in Africa, 26.5% to 32.6% of females in Ethiopia, and 55% of females in Sudan [7,8]. Underreporting and unmet needs are exacerbated in low-resource settings such as Somaliland by societal taboos, limited access to sanitary goods, and poor health infrastructure [9]. A 2025 study in the Somali region of Ethiopia revealed a 29.1% prevalence among teenage girls, highlighting understudied regional concerns. In neighboring Somalia, up to 60% of reproductive-age women report menstrual difficulties, including irregular cycles and heavy bleeding. These figures align with the 2020 Somaliland Health and Demographic Survey (SLHDS), which highlights indirect proxies like a maternal mortality ratio (MMR) of ~732 per 100,000 live births, reflecting broader reproductive health neglect [10,11]. Menstrual cycle characteristics have been associated with age, endocrine conditions, reproductive factors (e.g., age at menarche and parity), and modifiable lifestyle factors, including weight, physical activity, eating disorders, smoking, and stress. Menstrual function may be associated with working conditions, especially shift work, and occupational chemical exposures [4,9,12]. Obesity can be accompanied by several neuroendocrine and ovarian dysfunctions. Likewise, weight loss, low body mass index (BMI), nutritional deficiencies, alcohol intake, genetic predisposition, adequate sleep, and environmental exposures, as central etiologic mechanisms for menstrual irregularities and disorders [6,8,12,13]. Menstrual cycle irregularity is a major gynecological problem and a source of anxiety to academic performance, social function, and families. Moreover, that menstrual irregularity has long-term risks, such as tinnitus, metabolic syndrome, anemia, rheumatoid arthritis, osteoporosis, infertility, future diabetes mellitus (DM), cardiovascular disease (CVD), hypertensive disorders, chronic renal failure, and ovarian cancer [2,7,14-16]. Many women in Somaliland are compelled to wear filthy clothes without underwear due to the lack of access to sanitary products and the country's traditional, pastoralist culture, which raises their risk of urogenital infections and irregular cycles. Female genital mutilation/cutting (FGM/C), which affects around 98%, exacerbates dysmenorrhea, severe bleeding, and abnormalities through scarring and structural changes, according to increased morbidity. Due to serious problems including water scarcity and inadequate privacy in displacement camps, these risks are more prevalent in peri-urban Hargeisa [17]. Somaliland's post-conflict health system sustains low detection rates and untreated irregularities, contributing to broader reproductive inequities, with only one gynecologist per 100,000 women, reliance on underfunded facilities like KAAH Hospital, and low prenatal care uptake (47% facility attendance, 33% skilled birth attendants). Despite links to holistic well-being—which encompasses physical, mental, and social dimensions—there are gaps in conflict where statistics on prevalence and modifiable variables are still absent [18]. Problematic menstrual cycle features have been reported to affect high proportions of adolescent girls, women, and people who menstruate. Many women experience one or more menstrual disorders, including premenstrual tension, irregular and severe period pain, and heavy menstrual bleeding. Identifying menstrual patterns and associated factors is the first step to understand women’s health, examine the long-term effects of reproductive experience, and endocrine function [4,12,19,20]. Menstrual health is defined as a state of complete physical, mental, and social well-being in relation to the menstrual cycle, rather than just the absence of disease or infirmity [21]. Thus, the purpose of this study was to determine the prevalence of irregular menstruation and the characteristics that are linked to it among reproductive women who visit KAAH Hospital in Hargeisa, Somaliland, aligning with SDG 5 (Gender Equality) and WHO's 2023 menstrual health framework, to inform Sustainable Development Goal 3 (Good Health and Well-Being), given Somaliland's 21.8% ovulatory knowledge gap among youth [22]. METHODS Study design and setting A cross-sectional hospital-based study design was adopted to examine the prevalence and associated determinants of monthly irregularities among women of reproductive age (15-49 years), attending KAAH Hospital in Hargeisa, Somaliland, for any medical services. The investigation was carried out from March to May 2025, a duration of 3 months. Study participants Women aged 15-49 years who were attending KAAH Hospital and provided informed consent were eligible for inclusion. Pregnant or postpartum women (within 6 weeks of delivery), those undergoing treatment for diagnosed gynaecologic conditions and individuals unwilling to provide consent or unable to complete the interview were excluded from this study. Sample size and sampling technique The sample size was calculated using the single population proportion formula: where n is required sample size, z is Z-score for 95% confidence level (1.96), p is the estimated prevalence of menstrual irregularities (25%, based on data from similar studies in Ethiopia), and d is the margin of error (0.05 or 5%), with sample size was 288 participants. A convenience sampling technique was used, with eligible women consecutively recruited from outpatient clinics until the target sample size was achieved. Data collection A standardized questionnaire, developed for this study (see Supplementary file), given by the interviewer was used to gather data. The tool captured sociodemographic characteristics, menstrual history and irregularities, lifestyle behaviours (such as diet, sleep adequacy evaluated throughout the previous week, with less than seven hours, and substance use), psychosocial factors (including stress via Perceived Stress Scale/PSS and anxiety via Generalized Anxiety Disorder-7/GAD-7), and relevant medical history (PCOS and thyroid disorders). For a selection of subjects with suspected hormonal abnormalities (based on history), accessible laboratory assessments (e.g., FSH, LH, TSH, prolactin) were evaluated from hospital records. To guarantee cultural sensitivity and reduce bias, trained female research assistants who were fluent in both Somali and English administered the questionnaire. Each interview lasted 15–20 minutes and was conducted in a secluded area of the hospital. Quality control To ensure data quality, the questionnaire was pre-tested on 5% (n=15) of the sample at a nearby non-study facility two weeks prior to full implementation, with revisions made based on feedback for clarity and cultural appropriateness. Questionnaires have been reviewed daily for completeness and consistency, by the principal investigator. Additionally, double data entry has been carried out to limit the chance of errors during data processing. Ethical considerations included obtaining institutional review board approval from KAAH Hospital Ethics Committee and ensuring participant confidentiality. Variables Menstrual irregularity, which was self-reported over the previous 12 months and was defined as periods shorter than 21 days, longer than 35 days, or with fluctuations exceeding 7 days between cycles, was the main outcome variable. Standardized questions on cycle length, frequency, duration, and flow volume were used to evaluate this. Independent variables encompassed sociodemographic factors (age, marital status, education, and monthly income), hormonal and medical conditions (such as PCOS, thyroid dysfunction), psychosocial aspects (including stress and anxiety symptoms), and lifestyle behaviours (diet, smoking, alcohol use, and sleep adequacy). Statistical analysis All participant responses were numerically coded and subsequently entered into PSPP-software (version 1.6.2) for statistical analysis. The dataset was summarized using descriptive statistics, such as percentages and frequencies. Bivariate analysis (chi-square tests) identified variables associated with irregular menstruation at a significance level of p < 0.05. To encourage clarity and ease understanding, the statistics were thoughtfully shown using tables. RESULTS Table 1 shows that age is significant associated with menstrual irregularity among 247 participants ( p <0.001), with menstrual irregularity is most common in those aged 25 to 29 compared with another age groups. This implies that hormonal stability and reproductive function may be impacted by aging, which could lead to irregular menstrual cycles. Similarly, there was a strong and statistically significant correlation ( p <0.001) between monthly income and irregular cycles, with lower income (<$100) having the highest occurrence. The incidences of irregular periods were significantly higher in 81 women with a diagnosis of hormonal imbalance ( p -value <0.001). Menstrual irregularity was substantially associated with psychological characteristics such as recent stress (n=167, p =0.039) and anxiety symptoms (n=102, p =0.018). Emotional stress and mental health disturbances could affect the hypothalamic-pituitary-ovarian axis, leading to hormonal fluctuations that disrupt the menstrual cycle. Diet type also played a crucial role. Women who consumed unhealthy diets (66.26%) and inadequacy sleep (<7 hours/night; 71.95%) were significantly more likely to report irregular menstruation ( p <0.001). Poor sleep quality may disrupt melatonin and ovarian hormones. Table 1 Sociodemographic and clinical characteristics by menstrual regularity status (n=288) Variables Menstrual irregularity status P- value Yes (n=247) No (n=41) Age category 15-19 20-24 25-29 30-34 ≥35 45 (18.29%) 80 (32.52%) 84 (34.15%) 31 (12.6%) 7 (2.85%) 3 (7.31%) 6 (14.63%) 13 (31.71%) 12 (29.27%) 7 (17.07%) <0.001 Marital status Single Married Divorced/Widowed 85 (34.55%) 150 (60.98%) 12 (4.88%) 19 (46.34%) 22 (53.66%) 0 (34.55%) 0.55 Educational level No formal education Primary Secondary Tertiary 65(26.3%) 27(10.9%) 52(21.1%) 103(41.7%) 6(14.6%) 3(7.3%) 10(24.4%) 22(53.7%) 0.292 Monthly income <100$ 100-199$ 200-299$ ≥300$ 96 (39.02%) 76 (30.89%) 41 (16.26%) 34 (13.82%) 9 (21.95%) 10 (24.39%) 11 (29.27%) 12 (31.71%) <0.001 Hormonal imbalance (diagnosed/self-reported) Yes No 81 (32.93%) 166 (67.48%) 4 (9.76%) 37 (90.24%) 14; recent 1 month) Yes No 167 (67.89%) 80 (32.11%) 21 (51.22%) 20 (48.78%) 0.039 Anxiety symptoms (GAD-7 score>10; past 2 weeks) Yes No 102 (41.46%) 145 (58.94%) 10 (24.39%) 31 (75.61%) 0.018 Diet type Unhealthy Healthy 163 (66.26%) 84 (33.74%) 15 (36.59%) 26 (63.41%) <0.001 Smoking Yes No 1 (0.4%) 246 (99.6%) 0 (0%) 41(100%) 0.15 Alcohol consumption Yes No 1 (0.4%) 246 (99.6%) 0 (0%) 41(100%) 0.53 Sleep adequacy (<7 hours hours/night; past week) Yes No 177 (71.95%) 70 (28.05%) 31 (75.61%) 10 (24.39%) <0.001 The hormonal assessment revealed that 13.84% of the individuals had low TSH and 18.46% had high TSH, while FT4 (3.07% high) and FT3 (7.69% low and 12.30% high) showed thyroid hormone abnormalities. High TSH reflected subclinical hypothyroidism. In terms of gonadotropins, 24.61% had low LH and 12.30% had low and 4.61% high FSH, suggesting potential problems (PSCOS) with ovarian function. Prolactin levels with 1.53% showed low and high levels were notable for galactorrhoea/amenorrhea (Table 2). Table 2 Hormonal assessments among participants with available laboratory data Hormone Value Range Frequency (n) Percent (%) Reference interpretation TSH (uIU/ml) Low (< 0.4) 9 13.84% Elevated TSH suggests subclinical hypothyroidism, disrupting GnRH pulsatility and causing menorrhagia/oligomenorrhea. A low TSH usually indicates that the thyroid is producing too much thyroid hormone. High (> 4.0) 12 18.46% FT3 (pg/ml) Low ( 4.2) 8 12.30% FT4 (ng/dl) Low ( 1.7) 2 3.07% Prolactin (ng/ml) Low 1 1.53% Hyperprolactinemia may inhibit GnRH, leading to galactorrhea and amenorrhea. While low may lead to infertility and inadequate milk production in women after childbirth High 1 1.53% FSH (mIU/ml) Low 8 12.30% Elevated levels indicate potential diminished ovarian reserve or anovulatory cycles, increasing risks of oligomenorrhea and future infertility. While low might indicate pituitary or hypothalamic issues that impact the menstrual cycle and ovulation High 3 4.61% LH (mIU/ml) Low 16 24.61% A low level of LH means the body isn’t producing or releasing enough of the hormone. This can interfere with ovulation and fertility High 0 0.0% DISCUSSION The study found a very high prevalence of menstrual irregularities (85.76%) in women of reproductive age who attended KAAH Hospital. The analysis was able to assess a number of factors significantly associated with menstrual irregularities, the identified variables factors including age, income per month, hormonal imbalance, psychological stress and anxiety symptoms, diet, and sleep sufficiency. Socio-demographical factors like education level and marital status, as well as behavioural factors like smoking and alcohol use, showed no statistical association with irregular menstrual cycles. An analysis of participant hormones showed that though the majority presented with normal thyroid and prolactin levels, a notable portion presented with low gonadotropin (FSH and LH) levels, which seems to indicate some level of ovarian disruption that could likely be a factor in contributing to irregular menstrual cycles. Menstrual abnormalities entail a combination of one or more unfavourable symptoms linked to the menstrual cycle, and a similar occurrence rate of menstrual disorder [20]. The prevalence of menstrual irregularity in the current study was consistent with studies conducted in Republic of Korea, Ethiopia, Bangladesh, and Zimbabwe. Twenty-one percent women reported irregular menstrual cycles and 5.43% reported that their cycle were always irregular (range 22-45 years) [4]. Out of the total study participants, 32.60% had irregular menstruation [2]. Twenty-nine percent reported experiencing an irregular menstrual cycle [7]. Additionally, 17.70-21.80% reported irregular menstruation [21,23]. Irregular menstrual cycles were associated with young age and the score of perceived stress, anxiety, and sleep problems were higher in women with irregular cycles than in those with regular cycles. The variability and length of the menstrual cycle decreased with increasing age [4]. Late adolescence is period of continued hormonal adjustments as the hypothalamic-pituitary-ovarian (HPO) axis matures, which may result in delayed stabilization of menstrual cycles, where young women experiencing post-conflict pressures were more at risk due to early menarche [7]. The irregularity in youngsters, this often happens because their bodies have not yet settled into a pattern of regular menstrual cycles. Younger females is that they may experience rapid and dramatic biological processes associated with the transitions to and through puberty [8,24,25]. Most participants in southwestern China (69.70%) reported that their menstrual cycles were irregular with 37.80% had mild anxiety symptoms [5]. Literature review mentioned a wide range of prevalence of menstrual disorder ranging from 60-80% [20]. Factors that were significantly associated with menstrual irregularity were sleep hour and perceived stress. When the stress level is high, the hypothalamic-pituitary-adrenal (HPA) axis activity is interrupted, that may leads to have irregularities experience [2]. The menstrual cycle is regulated by the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, and stress can inhibit the secretion of this hormone through the HPA axis. This is attributed to the activation of the corticotrophin-releasing hormone system in response to stress, which can disrupt menstrual function [5,21]. Menstrual dysfunction may be related to decreased sex hormone-binding globulin and alterations in the hypothalamic-pituitary-ovarian axis. Stress has been associated with functional hypothalamic amenorrhea which characterized by the suppression of gonadotropin releasing hormone pulsatility [4]. Environmental, social, and physical stressors all trigger the release of different hormones and are associated with dysregulation of HPA axis activity. This further disrupts the normal functioning of the HPA axis, leading to irregular menstrual cycles or disruptions in other reproductive mechanisms [26]. Women who consumed more coffee and alcohol were less likely to have long menstrual cycles [4,27]. Normal circadian rhythmicity and sleeps awake disruption which regulates the secretion of hormones (melatonin, cortisol, thyroid-stimulating hormone, and prolactin), as a result, menstrual irregularity may occur [2,7]. An imbalance in melatonin causes changes like sleep debt in the evening-type menstrual cycle, suppress the secretion of gonadotropin-releasing hormones, and affect ovulation [28]. Among the risk factors identified for menstrual disorders, lifestyle emerged (dietary changes) as the most frequently cited factor in studies analysed. They consequently change their eating habits because they frequently go toward fast food. These has been a recent increase in the prevalence of PCOS disease [20]. Maintain a low weight and fat percentage, performance, or sociocultural reasons, may suffer from low energy availability and also menstrual dysfunction. Anxiety could have altered the food intake, which might have affected menstrual irregularities [25,29]. Food cravers for high-fat and sweet foods were likely to have irregular menstrual cycle, otherwise subjects consuming vitamin A-rich plant foods less likely suffering from irregular menstrual cycle. Many women use eating as a coping strategy to momentarily ease unpleasant feelings. The higher release of progesterone and lower level of oestrogen during the late luteal phase contribute to a desire to consume more high-fat and sweet foods. Additionally, vitamin A can lead to increased production of prostaglandins, hormone-like substances that may contribute to menstruation [30]. Nutrient-rich patterns reduced prostaglandin increases, but diets deficient in fish, nuts, fruits, and vegetables made symptoms worse [31]. The possible justification for this might be due irregularity of menstruation could fluctuate steroid hormones and unexpected occurrence of menses irregularly in such a young age with less physical and psychological maturity [1]. Hormone levels may be a factor in irregular menstruation. Both hypothyroidism and hyperthyroidism are associated with change in concentrations of sex hormones in both sexes, ovulatory function in women [13]. The ovaries are directly impacted by thyroid hormones, which also indirectly interact with sex hormone-binding globulin. These gonadotropin deficiencies are consistent with findings of thyroid-ovarian disease in low-resource environments, suggesting subclinical PCOS loads [2,7]. The endocrinal profiles of adolescent girls with menstrual irregularities are summarized that thyroid dysfunction (7.38%), biochemical hyperandrogenism (14.91%), and hyperprolactinemia (1.20%) were presented [32]. Family income levels associated with menstruation irregularity. Low income was found to be a proxy for unmet menstrual hygiene needs in Africa due to heavy menstrual bleeding. Due to delayed care-seeking and nutritional deficiencies, economic constraints probably exacerbate cycle disturbances [33,34]. Limitations There are significant limitations to this cross-sectional, hospital-based investigation. Its architecture makes it impossible to prove causation for related variables. Due to symptomatic bias, selection and convenience sampling at KAAH Hospital may overstate prevalence (85.76%), limiting generalizability to Somaliland's rural or community populations. Despite cultural precautions, self-reported data is susceptible to recollection and stigma-related biases. Multivariate models are required. Only subsets were covered by the lab data, and the timeframe of March–May 2025 might be influenced by seasonal factors like Ramadan. Conclusion This study reveals a startling 85.76% prevalence of monthly irregularities among reproductive-age women at KAAH Hospital, Hargeisa. These irregularities are caused by a number of factors, including age (25–29 peak), low income, hormonal disturbances (low FSH/LH), stress/anxiety, poor food, and sleep deficits, by providing a more holistic understanding of menstrual health that encompassed both psychosocial and biological health domains applicable to this population. In order to reduce long-term risks including infertility and metabolic disorders, identification of abnormal menstrual patterns that combine gynaecological, mental, and nutritional care may permit early detection of potential health problems and holistic interventions. Gender equity and well-being will be advanced by investing in Somaliland's health systems, which will empower women. Start educating the community on ovulatory awareness and sanitary access through schools and mosques, focusing on low-income individuals (less than $100 per month) and those aged 25 to 29. Future studies should test nutritional supplements (vitamin A-rich therapies) for high-risk categories or use longitudinal designs to monitor FGM/C-sleep correlations. Multivariate regression, experimental supplements and counselling in post-conflict settings, and representative samples should all be included in future long-term studies. Abbreviations AUB: Abnormal Uterine Bleeding; BMI: Body Mass Index; CVD: Cardiovascular Disease; DM: Diabetes Mellitus; FGM/C: Female Genital Mutilation/Cutting; FSH: Follicle-Stimulating Hormone; FT3: Free Triiodothyronine; FT4: Free Thyroxine; GAD-7: Generalized Anxiety Disorder-7; GnRH: Gonadotropin-Releasing Hormone; HPA: Hypothalamic-Pituitary-Adrenal; HPO: Hypothalamic-Pituitary-Ovarian; IRB: Institutional Review Board; LH: Luteinizing Hormone; MMR: Maternal Mortality Ratio; PCOS: Polycystic Ovary Syndrome; PSS: Perceived Stress Scale; SDG: Sustainable Development Goal; SLHDS: Somaliland Health and Demographic Survey; TSH: Thyroid-Stimulating Hormone; WHO: World Health Organization Declarations Acknowledgment We sincerely thank the Hargeisa women who took part in this study and shared their experiences in spite of cultural concerns. We would especially want to thank the outpatient clinic staff and the administration of KAAH Hospital for providing support and their steadfast assistance in recruiting participants. Authors’ contributions Under AI's supervision, RA and HA planned the study, created the methodology, gathered and examined data, and wrote the first draft of the manuscript. PG oversaw data analysis, contributed to result interpretation, offered professional advice on study design, and critically edited the paper for intellectual substance and publishing preparation. Each author agreed to take responsibility for the accuracy and integrity of the work and contributed to the final manuscript approval. Funding This work has not received any funding to support this work. Availability of data and materials The dataset used and analysed during the current study is available from the corresponding author on reasonable request. Ethical considerations Ethical approval was secured from the appropriate Institutional Review Board (IRB) of KAAH Hospital. Informed consent had been obtained from all participants after explaining the study's purpose, confidentiality, and voluntary nature. Prior to enrolment, informed consent was obtained from the parents or legal guardians of participants under the age of 16 (i.e., 15-year-olds), in addition to verbal assent from the individuals themselves when possible. All participants gave their informed consent after being informed in Somali or English of the study's goals, methods, risks, and advantages; low-literate women gave their verbal approval. Participants could leave at any moment without having an impact on care. Anonymized data storage, password-protected digital entry, and limited access to the study team were all used to guarantee confidentiality. There were no rewards offered to prevent coercion. After publication, data will be kept for five years for auditing purposes before being safely destroyed. This inquiry adhered to the Declaration of Helsinki's requirements. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1 Undergraduate student of Bachelor Medical Laboratory, Edna Adan University, Hargeisa, Somaliland 2 Undergraduate student of Bachelor Medical Laboratory, Edna Adan University, Hargeisa, Somaliland 3 Department of Master Public Health, Edna Adan University, Hargeisa, Somaliland 4 Dean of Medical Laboratory Sciences, Edna Adan University, Hargeisa, Somaliland References Eshetu N, Abebe H, Fikadu E. Premenstrual syndrome, coping mechanisms and associated factors among Wolkite university female regular students, Ethiopia, 2021. BMC Women’s Health , 2022; 22(88):1-11. Zeru AB, Gebeyaw ED, Ayele ET. Magnitude and associated factors of menstrual irregularity among undergraduate students of Debre Berhan University, Ethiopia. Reprod Health, 2021; 18(101):1-8. Khan GA, Althubaiti A, Alshrif A. Dysmenorrhea, intermenstrual bleeding, menstrual flow volume changes, and irregularities following COVID-19 vaccination and the association with vaccine skepticism: a retrospective observational study. Women’s Health (Lond.), 2023; 19:1-9. Song S, Choi H, Pang Y. Factors associated with regularity and length of menstrual cycle: Korea Nurses’ Health Study. BMC Women’s Health, 2022; 23(361):1-12. Gao F, Wei Z, He J. The relationship between menstrual issues and depressive and anxiety symptoms in Chinese adolescent female inpatients: a cross-sectional questionnaire-based investigation. BMC Psychology, 2025; 13(675):1-10. Ukoaka BM, Abiodun AH, Daniel FM. The burden of menstrual irregularities among women living with HIV in Nigeria: a comprehensive review. Reprod Health, 2024; 21(156):1-14. Hussein N, Shiferaw K, Lonsako AA. Menstrual irregularity and associated factors among female adolescents in Somali region high schools Ethiopia 2023. Sci Rep , 2025; 15(1):1-10. Mittiku YM, Mekonen H, Wogie G. Menstrual irregularity and its associated factors among college students in Ethiopia, 2021. Front Glob Womens Health, 2021; 3:1-9. Harley KG, Watson A, Robertson S. Menstrual cycle characteristics of U.S. adolescents according to gynecological age and age at menarche. J Pediatr Adolesc Gynecol , 2024; 37(4):419-25. Egal JA, Kiruja J, Litorp. Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria: a prospective cross-sectional study in a national referral hospital. Int J Gynecol Obstet, 2022; 159:856-64. Ministry of Planning and National Development. The Somaliland Health and Demographic Survey [eBook] . Somaliland Government: UNFPA. 2020. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjaz8_98sCEAxUOgP0HHT0VDNAQFnoECA4QAQ&url=https%3A%2F%2Fsomalia.unfpa.org%2Fsites%2Fdefault%2Ffiles%2Fpub-pdf%2Fslhds2020_report_2020.pdf&usg=AOvVaw2kRc8_BPXparJTqnB5-KYI&opi=89978449 Alemu BW, Waljer M, Tooth LR. The association between menstrual disorders and workforce participation: a prospective longitudinal. BJOG, 2025; 132(7):961-71. Xiaoyang L, Yang H, Yan M. The mediating role of menstrual irregularity on obesity and sexual function in Chinese women with pelvic floor disorders: a cross-sectional study. BMC Women’s Health, 2023; 23(462):1-9. Kiyak S, Bati S. The relationship between menstrual cycle pattern and post-traumatic stress in women following the 2023 earthquake in Turkey. Brain Behav , 2024; 14(9):1-10. Attia GM, Alharbi OA, Aljohani RM. The impact of irregular menstruation on health: a review of the literature. Cureus, 2023; 15(11):1-9. Matsumura Y, Yamamoto R, Shinzawa M. Psychological and physical stress response and incidence of irregular menstruation in female university employees: a retrospective cohort study. J Epidemiol, 2025; 35(10):425-431. Agbakwu CE, Fox KA, Thomas AB. Influence of female genital mutilation/cutting on health morbidity, health service utilization and satisfaction with care among Somali women and teenage girls in the United States. J Racial Ethn Health Disparities, 2022; 10(2):788-96. Maregn RT, Bourret K, Egal JA. Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system. BMJ Open, 2023; 13(3):1-8. Sawyer G, Howe LD, Abigail Fraser. Menstrual cycle features in mothers and daughters in the Avon Longitudinal Study of Parents and Children (ALSPAC). Wellcome Open Res, 2023; 8(386):1-47. Das P, Jungari S. Prevalence, risk factors and health-seeking behavior of menstrual disorders among women in India: a review of two-decade evidence. Glob Health Action, 2024; 17(1):1-11. Eva SK, Aufi SS, Mamun AS. Depression and its association with menstrual disturbance among female university students: a cross—sectional study. BMJ Public Health, 2024; 2(2):1-8. Ali AO, Abdi A, Egge A. Exploring the magnitude and determinants of ovulatory period knowledge among young women in Somalia: a multilevel analysis utilizing data from the 2020 Somali Health and Demographic Survey (SHDS). Discover Public Health, 2025; 22(498):1-16. Madziyire MG, Magwali TL, Chikwasha V. The causes of infertility in women presenting to gynaecology clinics in Harare, Zimbabwe; a cross sectional study. Fertil Res Pract, 2021; 7(1):1-8. Wastila L, Fu YH, Tung CC. Association between vaccination for human papillomavirus (HPV) and autonomic dysfunction and menstrual irregularities: a self-controlled case series analysis. Drugs Real World Outcomes, 2025; 12(3):467-77. Ravi S, Ihalainen JK, Mikkonen RS. Self-reported restrictive eating, eating disorders, menstrual dysfunction, and injuries in athletes competing at different levels and sports. Nutrients, 2021; 13(3275):1-11. Bhardwaj P, Yadav SK, Taneja J. Magnitude and associated factors of menstrual irregularity among young girls: a cross-sectional study during COVID-19 second wave in India. J Family Med Prim Care, 2022; 11(12):7769-75. Kucukerdem HS, Ozdemir TD. Evaluation of menstrual irregularities following COVID-19 infection or vaccination: the impact of COVID anxiety and associated risk factors. Medicine, 2024; 103(26):1-6. Jung HN, Suh D, Jeong WC. Associations of chronotype and insomnia with menstrual problem in newly employed nurses at university hospitals in the Republic of Korea. Ann Occup Environ Med, 2023; 35:1-13. Miyamoto M, Hanatani Y, Shibuya K. Relationship among nutritional intake, anxiety, and menstrual irregularity in Elite Rowers. Nutrients, 2021; 13(3436):1-7. Sen LC, Jahan I, Salekin N. Food craving, vitamin A, and menstrual disorders: a comprehensive study on university female students. PLoS One, 2024; 19(9):1-19. Mussa I, Jibro U, Balis B. Burden of irregular menstrual cycle and its predictors among reproductive-age women in Ethiopia: systematic review and meta-analysis. SAGE Open Med, 2024; 12:1-12. Patel S, Pushpalatha K, Singh B. Evaluation of hormonal profile and ovarian morphology among adolescent girls with menstrual irregularities in a tertiary care centre at Central India. Scientific World Journal, 2022; 3047526: 1-8. Misra A, Wolfe O, Azziz R. The impact of childhood abuse and neglect on the development of features of polycystic ovary syndrome: a pilot study. Womens Health Rep (New Rochelle), 2025; 6(1):412-20. Obeagu, Ifeanyi E. Prevalence and risk factors of heavy menstrual bleeding in Africa: a narrative review. Annals of Medicine & Surgery, 2025; 87(7):4194-4200. Additional Declarations No competing interests reported. Supplementary Files QuestionnaireR.6.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Apr, 2026 Reviews received at journal 05 Apr, 2026 Reviewers agreed at journal 21 Mar, 2026 Reviewers agreed at journal 21 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviews received at journal 24 Jan, 2026 Reviewers agreed at journal 18 Jan, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers invited by journal 12 Jan, 2026 Editor assigned by journal 12 Jan, 2026 Editor invited by journal 01 Jan, 2026 Submission checks completed at journal 31 Dec, 2025 First submitted to journal 31 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8436991","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":573247237,"identity":"c8534bc6-de62-4891-9105-85151ce6c243","order_by":0,"name":"Ramla Adam","email":"","orcid":"","institution":"Edna Adan University","correspondingAuthor":false,"prefix":"","firstName":"Ramla","middleName":"","lastName":"Adam","suffix":""},{"id":573247238,"identity":"e432ab6d-3316-4880-8e3b-339c4bcdb593","order_by":1,"name":"Abdiwahab Hassan","email":"","orcid":"","institution":"Edna Adan University","correspondingAuthor":false,"prefix":"","firstName":"Abdiwahab","middleName":"","lastName":"Hassan","suffix":""},{"id":573247239,"identity":"ee0ed3b4-5ce1-4ddc-8c30-842dcdcac7f4","order_by":2,"name":"Peiter Gideon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYFACxgYQycNwAEh+AGI2dsJaGhtgWhhngLQwE2sNSAszD4hBSIs5e3P7g497amX4jjcfe2zza5s8HzMD44ePObi1WPYcbGyc8ew4j+SZY+nGuX23DduYGZglZ27DrcXgRmJjM8+BYzwGN3LMpHN7bjMCtbAx8+LTcv9hY/MfkJb7b8ykLXtu2xPWcoOxsZnhQA3QFh4zaYYftxMJarHsSWyc2XPgANAvaWmSvQ23k9uYGZvx+sWc/fiDDz8O1NnzHT98TOLHn9u289ubD374iM9hEOowhGJsA5MNuNUjtNRBuX/wKh4Fo2AUjIIRCgBcJVeTmuP9TQAAAABJRU5ErkJggg==","orcid":"","institution":"Edna Adan University","correspondingAuthor":true,"prefix":"","firstName":"Peiter","middleName":"","lastName":"Gideon","suffix":""},{"id":573247240,"identity":"b57e1335-5e5b-4d38-99e2-66f0f5bf6df6","order_by":3,"name":"Abdirasaq Ismail","email":"","orcid":"","institution":"Edna Adan University","correspondingAuthor":false,"prefix":"","firstName":"Abdirasaq","middleName":"","lastName":"Ismail","suffix":""}],"badges":[],"createdAt":"2025-12-23 20:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8436991/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8436991/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100247740,"identity":"d6d58c82-8b5a-4f5b-bbac-3fdfd3c742ec","added_by":"auto","created_at":"2026-01-14 14:28:14","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":42873,"visible":true,"origin":"","legend":"","description":"","filename":"Research6.docx","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/b31731fd07bdc30a64f3a710.docx"},{"id":100370772,"identity":"03f3bb67-de77-4bf7-9b66-1a168253586e","added_by":"auto","created_at":"2026-01-16 08:08:12","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6695,"visible":true,"origin":"","legend":"","description":"","filename":"ef3d7052c28743f980f4c7b118b2ac61.json","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/a65df9119f107da8ac924e7a.json"},{"id":100247743,"identity":"afab39cf-4363-4633-bb74-37931dbcb495","added_by":"auto","created_at":"2026-01-14 14:28:14","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17361,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireR.6.docx","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/e942c5a3677b5ad625049723.docx"},{"id":100247744,"identity":"399d4c32-6158-41a6-89db-3f306a2ffe74","added_by":"auto","created_at":"2026-01-14 14:28:14","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100077,"visible":true,"origin":"","legend":"","description":"","filename":"ef3d7052c28743f980f4c7b118b2ac611enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/af00a4d6e8c3e0fcc12209a6.xml"},{"id":100372083,"identity":"3fe66215-f016-46c1-b5c1-79eb91f4299f","added_by":"auto","created_at":"2026-01-16 08:11:36","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97858,"visible":true,"origin":"","legend":"","description":"","filename":"ef3d7052c28743f980f4c7b118b2ac611structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/bfd8cda01d4a8beec2c93c27.xml"},{"id":100247746,"identity":"97fac482-d82f-4580-bef8-1a505e11d81b","added_by":"auto","created_at":"2026-01-14 14:28:14","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108338,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/a62fa3eed8a87dbcf86829af.html"},{"id":100383542,"identity":"20659f28-0f66-4c08-9977-55f8cc2cf10d","added_by":"auto","created_at":"2026-01-16 10:47:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":887769,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/d6cc5d82-fb0d-478f-8b44-7918fe1b8a08.pdf"},{"id":100247742,"identity":"e9bf635b-d321-4910-a0c7-02783e175fc4","added_by":"auto","created_at":"2026-01-14 14:28:14","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17361,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireR.6.docx","url":"https://assets-eu.researchsquare.com/files/rs-8436991/v1/4a61ccf210772f189b3f25b0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrevalence and Associated Factors of Menstrual Irregularities Among Reproductive-age Women Attending Kaah Hospital, Hargeisa, Somaliland: A Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eMenstruation is a cyclic physiological process and natural part of a woman\u0026rsquo;s life characterized by the flow of blood and endometrium from the uterine cavity. Menstrual cycle (counting from the first day of one menstrual period to the first day of the next cycle) is 21 to 35 days and lasts from 3 to 7 days duration with a volume of blood loss of 5-80 ml, this process serves as a sensitive barometer of endocrine equilibrium and overall well-being [1,2]. Process of menstruation is tightly controlled by the hypothalamus, pituitary gland, ovaries (estrogen and progesterone), and uterus endometrium. The menstrual cycle is divided into follicular and luteal phases, separated by ovulation, and regularity and length of cycles are considered as markers of endocrine function and reproductive health. The rigidity of this regulation makes menstruation highly sensitive to internal as well as external stressors, either physical, psychological, or social [3,4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMenstrual disorders\u0026mdash;defined as cycles shorter than 21 days, longer than 35 days, or with variations exceeding 7 days\u0026mdash;include disruption of menstrual patterns, ovarian dysfunction and menstrual pain, impacting 5\u0026ndash;30% of women worldwide who are in reproductive age [4,5]. Menstrual irregularity refers to any kind of changes occurring irregularity of onset, frequency of onset, duration of flow, and volume, such as irregular cycle length, anovulatory cycles, and luteal phase defects. It is most prevalent in the 21-25 years age group (85%) and constitute a leading impetus for gynecological consultations worldwide. Menstrual disorders are affecting the menstrual cycle, such as abnormal uterine bleeding (AUB), dysmenorrhea, menorrhagia, metrorrhagia, oligomenorrhea, amenorrhea, and polymenorrhagia [2,6]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMenstrual-related problems affect an estimated 500 million people worldwide, with prevalence rates ranging from 23-76.6%. Period irregularities were reported by 12.5% to 55% of teenage girls in Africa, 26.5% to 32.6% of females in Ethiopia, and 55% of females in Sudan [7,8]. Underreporting and unmet needs are exacerbated in low-resource settings such as Somaliland by societal taboos, limited access to sanitary goods, and poor health infrastructure [9]. A 2025 study in the Somali region of Ethiopia revealed a 29.1% prevalence among teenage girls, highlighting understudied regional concerns. In neighboring Somalia, up to 60% of reproductive-age women report menstrual difficulties, including irregular cycles and heavy bleeding. These figures align with the 2020 Somaliland Health and Demographic Survey (SLHDS), which highlights indirect proxies like a maternal mortality ratio (MMR) of ~732 per 100,000 live births, reflecting broader reproductive health neglect [10,11].\u003c/p\u003e\n\u003cp\u003eMenstrual cycle characteristics have been associated with age, endocrine conditions, reproductive factors (e.g., age at menarche and parity), and modifiable lifestyle factors, including weight, physical activity, eating disorders, smoking, and stress. Menstrual function may be associated with working conditions, especially shift work, and occupational chemical exposures [4,9,12]. Obesity can be accompanied by several neuroendocrine and ovarian dysfunctions. Likewise, weight loss, low body mass index (BMI), nutritional deficiencies, alcohol intake, genetic predisposition, adequate sleep, and environmental exposures, as central etiologic mechanisms for menstrual irregularities and disorders [6,8,12,13]. Menstrual cycle irregularity is a major gynecological problem and a source of anxiety to academic performance, social function, and families. Moreover, that menstrual irregularity has long-term risks, such as tinnitus, metabolic syndrome, anemia, rheumatoid arthritis, osteoporosis, infertility, future diabetes mellitus (DM), cardiovascular disease (CVD), hypertensive disorders, chronic renal failure, and ovarian cancer [2,7,14-16].\u003c/p\u003e\n\u003cp\u003eMany women in Somaliland are compelled to wear filthy clothes without underwear due to the lack of access to sanitary products and the country\u0026apos;s traditional, pastoralist culture, which raises their risk of urogenital infections and irregular cycles. Female genital mutilation/cutting (FGM/C), which affects around 98%, exacerbates dysmenorrhea, severe bleeding, and abnormalities through scarring and structural changes, according to increased morbidity. Due to serious problems including water scarcity and inadequate privacy in displacement camps, these risks are more prevalent in peri-urban Hargeisa [17]. Somaliland\u0026apos;s post-conflict health system sustains low detection rates and untreated irregularities, contributing to broader reproductive inequities, with only one gynecologist per 100,000 women, reliance on underfunded facilities like KAAH Hospital, and low prenatal care uptake (47% facility attendance, 33% skilled birth attendants). Despite links to holistic well-being\u0026mdash;which encompasses physical, mental, and social dimensions\u0026mdash;there are gaps in conflict where statistics on prevalence and modifiable variables are still absent [18].\u003c/p\u003e\n\u003cp\u003eProblematic menstrual cycle features have been reported to affect high proportions of adolescent girls, women, and people who menstruate. Many women experience one or more menstrual disorders, including premenstrual tension, irregular and severe period pain, and heavy menstrual bleeding. Identifying menstrual patterns and associated factors is the first step to understand women\u0026rsquo;s health, examine the long-term effects of reproductive experience, and endocrine function [4,12,19,20]. Menstrual health is defined as a state of complete physical, mental, and social well-being in relation to the menstrual cycle, rather than just the absence of disease or infirmity [21]. Thus, the purpose of this study was to determine the prevalence of irregular menstruation and the characteristics that are linked to it among reproductive women who visit KAAH Hospital in Hargeisa, Somaliland, aligning with SDG 5 (Gender Equality) and WHO\u0026apos;s 2023 menstrual health framework, to inform Sustainable Development Goal 3 (Good Health and Well-Being), given Somaliland\u0026apos;s 21.8% ovulatory knowledge gap among youth [22].\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional hospital-based study design was adopted to examine the prevalence and associated determinants of monthly irregularities among women of reproductive age (15-49 years), attending KAAH Hospital in Hargeisa, Somaliland, for any medical services. The investigation was carried out from March to May 2025, a duration of 3 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen aged 15-49 years who were attending KAAH Hospital and provided informed consent were eligible for inclusion. Pregnant or postpartum women (within 6 weeks of delivery), those undergoing treatment for diagnosed gynaecologic conditions and individuals unwilling to provide consent or unable to complete the interview were excluded from this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sampling technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using the single population proportion formula:\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1768400681.png\" width=\"145\" height=\"84\"\u003e\u003c/p\u003e\n\u003cp\u003ewhere n is required sample size, z is Z-score for 95% confidence level (1.96), \u003cem\u003ep\u003c/em\u003e is the estimated prevalence of menstrual irregularities (25%, based on data from similar studies in Ethiopia), and \u003cem\u003ed\u0026nbsp;\u003c/em\u003eis the margin of error (0.05 or 5%), with sample size was 288 participants. A convenience sampling technique was used, with eligible women consecutively recruited from outpatient clinics until the target sample size was achieved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA standardized questionnaire, developed for this study (see Supplementary file), given by the interviewer was used to gather data. The tool captured sociodemographic characteristics, menstrual history and irregularities, lifestyle behaviours (such as diet, sleep adequacy evaluated throughout the previous week, with less than seven hours, and substance use), psychosocial factors (including stress via Perceived Stress Scale/PSS and anxiety via Generalized Anxiety Disorder-7/GAD-7), and relevant medical history (PCOS and thyroid disorders). For a selection of subjects with suspected hormonal abnormalities (based on history), accessible laboratory assessments (e.g., FSH, LH, TSH, prolactin) were evaluated from hospital records. To guarantee cultural sensitivity and reduce bias, trained female research assistants who were fluent in both Somali and English administered the questionnaire. Each interview lasted 15\u0026ndash;20 minutes and was conducted in a secluded area of the hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure data quality, the questionnaire was pre-tested on 5% (n=15) of the sample at a nearby non-study facility two weeks prior to full implementation, with revisions made based on feedback for clarity and cultural appropriateness. Questionnaires have been reviewed daily for completeness and consistency, by the principal investigator. Additionally, double data entry has been carried out to limit the chance of errors during data processing. Ethical considerations included obtaining institutional review board approval from KAAH Hospital Ethics Committee and ensuring participant confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMenstrual irregularity, which was self-reported over the previous 12 months and was defined as periods shorter than 21 days, longer than 35 days, or with fluctuations exceeding 7 days between cycles, was the main outcome variable. Standardized questions on cycle length, frequency, duration, and flow volume were used to evaluate this. Independent variables encompassed sociodemographic factors (age, marital status, education, and monthly income), hormonal and medical conditions (such as PCOS, thyroid dysfunction), psychosocial aspects (including stress and anxiety symptoms), and lifestyle behaviours (diet, smoking, alcohol use, and sleep adequacy).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participant responses were numerically coded and subsequently entered into PSPP-software (version 1.6.2) for statistical analysis. The dataset was summarized using descriptive statistics, such as percentages and frequencies. Bivariate analysis (chi-square tests) identified variables associated with irregular menstruation at a significance level of p \u0026lt; 0.05. To encourage clarity and ease understanding, the statistics were thoughtfully shown using tables.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable 1 shows that age is significant associated with menstrual irregularity among 247 participants (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), with menstrual irregularity is most common in those aged 25 to 29 compared with another age groups. This implies that hormonal stability and reproductive function may be impacted by aging, which could lead to irregular menstrual cycles. Similarly, there was a strong and statistically significant correlation (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) between monthly income and irregular cycles, with lower income (\u0026lt;$100) having the highest occurrence. The incidences of irregular periods were significantly higher in 81 women with a diagnosis of hormonal imbalance (\u003cem\u003ep\u003c/em\u003e-value \u0026lt;0.001). Menstrual irregularity was substantially associated with psychological characteristics such as recent stress (n=167, \u003cem\u003ep\u003c/em\u003e=0.039) and anxiety symptoms (n=102, \u003cem\u003ep\u003c/em\u003e=0.018). Emotional stress and mental health disturbances could affect the hypothalamic-pituitary-ovarian axis, leading to hormonal fluctuations that disrupt the menstrual cycle. Diet type also played a crucial role. Women who consumed unhealthy diets (66.26%) and inadequacy sleep (\u0026lt;7 hours/night; 71.95%) were significantly more likely to report irregular menstruation (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). Poor sleep quality may disrupt melatonin and ovarian hormones.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Sociodemographic and clinical characteristics by menstrual regularity status (n=288)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMenstrual irregularity status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (n=247)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003cp\u003e\u0026ge;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e45 (18.29%)\u003c/p\u003e\n \u003cp\u003e80 (32.52%)\u003c/p\u003e\n \u003cp\u003e84 (34.15%)\u003c/p\u003e\n \u003cp\u003e31 (12.6%)\u003c/p\u003e\n \u003cp\u003e7 (2.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e3 (7.31%)\u003c/p\u003e\n \u003cp\u003e6 (14.63%)\u003c/p\u003e\n \u003cp\u003e13 (31.71%)\u003c/p\u003e\n \u003cp\u003e12 (29.27%)\u003c/p\u003e\n \u003cp\u003e7 (17.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced/Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e85 (34.55%)\u003c/p\u003e\n \u003cp\u003e150 (60.98%)\u003c/p\u003e\n \u003cp\u003e12 (4.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (46.34%)\u003c/p\u003e\n \u003cp\u003e22 (53.66%)\u003c/p\u003e\n \u003cp\u003e0 (34.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.55\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e65(26.3%)\u003c/p\u003e\n \u003cp\u003e27(10.9%)\u003c/p\u003e\n \u003cp\u003e52(21.1%)\u003c/p\u003e\n \u003cp\u003e103(41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(14.6%)\u003c/p\u003e\n \u003cp\u003e3(7.3%)\u003c/p\u003e\n \u003cp\u003e10(24.4%)\u003c/p\u003e\n \u003cp\u003e22(53.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.292\u003c/strong\u003e\u003c/p\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 valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly income\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;100$\u003c/p\u003e\n \u003cp\u003e100-199$\u003c/p\u003e\n \u003cp\u003e200-299$\u003c/p\u003e\n \u003cp\u003e\u0026ge;300$\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e96 (39.02%)\u003c/p\u003e\n \u003cp\u003e76 (30.89%)\u003c/p\u003e\n \u003cp\u003e41 (16.26%)\u003c/p\u003e\n \u003cp\u003e34 (13.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (21.95%)\u003c/p\u003e\n \u003cp\u003e10 (24.39%)\u003c/p\u003e\n \u003cp\u003e11 (29.27%)\u003c/p\u003e\n \u003cp\u003e12 (31.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHormonal imbalance (diagnosed/self-reported)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81 (32.93%)\u003c/p\u003e\n \u003cp\u003e166 (67.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (9.76%)\u003c/p\u003e\n \u003cp\u003e37 (90.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecent stress (high, PSS score\u0026gt;14; recent 1 month)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e167 (67.89%)\u003c/p\u003e\n \u003cp\u003e80 (32.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (51.22%)\u003c/p\u003e\n \u003cp\u003e20 (48.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety symptoms (GAD-7 score\u0026gt;10; past 2 weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e102 (41.46%)\u003c/p\u003e\n \u003cp\u003e145 (58.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (24.39%)\u003c/p\u003e\n \u003cp\u003e31 (75.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiet type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnhealthy\u003c/p\u003e\n \u003cp\u003eHealthy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e163 (66.26%)\u003c/p\u003e\n \u003cp\u003e84 (33.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (36.59%)\u003c/p\u003e\n \u003cp\u003e26 (63.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003cp\u003e246 (99.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e41(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol consumption\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003cp\u003e246 (99.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e41(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.53\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep adequacy (\u0026lt;7 hours hours/night; past week)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e177 (71.95%)\u003c/p\u003e\n \u003cp\u003e70 (28.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 (75.61%)\u003c/p\u003e\n \u003cp\u003e10 (24.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe hormonal assessment revealed that 13.84% of the individuals had low TSH and 18.46% had high TSH, while FT4 (3.07% high) and FT3 (7.69% low and 12.30% high) showed thyroid hormone abnormalities. High TSH reflected subclinical hypothyroidism. In terms of gonadotropins, 24.61% had low LH and 12.30% had low and 4.61% high FSH, suggesting potential problems (PSCOS) with ovarian function. Prolactin levels with 1.53% showed low and high levels were notable for galactorrhoea/amenorrhea (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Hormonal assessments among participants with available laboratory data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHormone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference interpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTSH (uIU/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow (\u0026lt; 0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eElevated TSH suggests subclinical hypothyroidism, disrupting GnRH pulsatility and causing menorrhagia/oligomenorrhea. A low TSH usually indicates that the thyroid is producing too much thyroid hormone.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh (\u0026gt; 4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.46%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFT3 (pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow (\u0026lt; 2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.69%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eA low FT3 level can indicate hypothyroidism and a high level for hyperthyroidism\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh (\u0026gt; 4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFT4 (ng/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow (\u0026lt; 0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eA high FT4 level indicates too much thyroid hormone (thyrotoxicosis), which can result from an overactive thyroid, inflammation, or taking excessive thyroid medication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh (\u0026gt; 1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.07%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eProlactin (ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.53%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHyperprolactinemia may inhibit GnRH, leading to galactorrhea and amenorrhea. While low may lead to infertility and inadequate milk production in women after childbirth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.53%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFSH (mIU/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eElevated levels indicate potential diminished ovarian reserve or anovulatory cycles, increasing risks of oligomenorrhea and future infertility. While low might indicate pituitary or hypothalamic issues that impact the menstrual cycle and ovulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.61%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLH (mIU/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eA low level of LH means the body isn\u0026rsquo;t producing or releasing enough of the hormone. This can interfere with ovulation and fertility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe study found a very high prevalence of menstrual irregularities (85.76%) in women of reproductive age who attended KAAH Hospital. The analysis was able to assess a number of factors significantly associated with menstrual irregularities, the identified variables factors including age, income per month, hormonal imbalance, psychological stress and anxiety symptoms, diet, and sleep sufficiency. Socio-demographical factors like education level and marital status, as well as behavioural factors like smoking and alcohol use, showed no statistical association with irregular menstrual cycles. An analysis of participant hormones showed that though the majority presented with normal thyroid and prolactin levels, a notable portion presented with low gonadotropin (FSH and LH) levels, which seems to indicate some level of ovarian disruption that could likely be a factor in contributing to irregular menstrual cycles.\u003c/p\u003e\n\u003cp\u003eMenstrual abnormalities entail a combination of one or more unfavourable symptoms linked to the menstrual cycle, and a similar occurrence rate of menstrual disorder [20]. The prevalence of menstrual irregularity in the current study was consistent with studies conducted in Republic of Korea, Ethiopia, Bangladesh, and Zimbabwe. Twenty-one percent women reported irregular menstrual cycles and 5.43% reported that their cycle were always irregular (range 22-45 years) [4]. Out of the total study participants, 32.60% had irregular menstruation [2]. Twenty-nine percent reported experiencing an irregular menstrual cycle [7]. Additionally, 17.70-21.80% reported irregular menstruation [21,23]. Irregular menstrual cycles were associated with young age and the score of perceived stress, anxiety, and sleep problems were higher in women with irregular cycles than in those with regular cycles. The variability and length of the menstrual cycle decreased with increasing age [4]. Late adolescence is period of continued hormonal adjustments as the hypothalamic-pituitary-ovarian (HPO) axis matures, which may result in delayed stabilization of menstrual cycles, where young women experiencing post-conflict pressures were more at risk due to early menarche [7]. The irregularity in youngsters, this often happens because their bodies have not yet settled into a pattern of regular menstrual cycles. Younger females is that they may experience rapid and dramatic biological processes associated with the transitions to and through puberty [8,24,25].\u003c/p\u003e\n\u003cp\u003eMost participants in southwestern China (69.70%) reported that their menstrual cycles were irregular with 37.80% had mild anxiety symptoms [5]. Literature review mentioned a wide range of prevalence of menstrual disorder ranging from 60-80% [20]. Factors that were significantly associated with menstrual irregularity were sleep hour and perceived stress. When the stress level is high, the hypothalamic-pituitary-adrenal (HPA) axis activity is interrupted, that may leads to have irregularities experience [2]. The menstrual cycle is regulated by the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, and stress can inhibit the secretion of this hormone through the HPA axis. This is attributed to the activation of the corticotrophin-releasing hormone system in response to stress, which can disrupt menstrual function [5,21]. \u0026nbsp;Menstrual dysfunction may be related to decreased sex hormone-binding globulin and alterations in the hypothalamic-pituitary-ovarian axis. Stress has been associated with functional hypothalamic amenorrhea which characterized by the suppression of gonadotropin releasing hormone pulsatility [4]. Environmental, social, and physical stressors all trigger the release of different hormones and are associated with dysregulation of HPA axis activity. This further disrupts the normal functioning of the HPA axis, leading to irregular menstrual cycles or disruptions in other reproductive mechanisms [26]. Women who consumed more coffee and alcohol were less likely to have long menstrual cycles [4,27].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNormal circadian rhythmicity and sleeps awake disruption which regulates the secretion of hormones (melatonin, cortisol, thyroid-stimulating hormone, and prolactin), as a result, menstrual irregularity may occur [2,7]. An imbalance in melatonin causes changes like sleep debt in the evening-type menstrual cycle, suppress the secretion of gonadotropin-releasing hormones, and affect ovulation [28]. Among the risk factors identified for menstrual disorders, lifestyle emerged (dietary changes) as the most frequently cited factor in studies analysed. They consequently change their eating habits because they frequently go toward fast food. These has been a recent increase in the prevalence of PCOS disease [20]. Maintain a low weight and fat percentage, performance, or sociocultural reasons, may suffer from low energy availability and also menstrual dysfunction. Anxiety could have altered the food intake, which might have affected menstrual irregularities [25,29]. Food cravers for high-fat and sweet foods were likely to have irregular menstrual cycle, otherwise subjects consuming vitamin A-rich plant foods less likely suffering from irregular menstrual cycle. Many women use eating as a coping strategy to momentarily ease unpleasant feelings. The higher release of progesterone and lower level of oestrogen during the late luteal phase contribute to a desire to consume more high-fat and sweet foods. Additionally, vitamin A can lead to increased production of prostaglandins, hormone-like substances that may contribute to menstruation [30]. Nutrient-rich patterns reduced prostaglandin increases, but diets deficient in fish, nuts, fruits, and vegetables made symptoms worse [31].\u003c/p\u003e\n\u003cp\u003eThe possible justification for this might be due irregularity of menstruation could fluctuate steroid hormones and unexpected occurrence of menses irregularly in such a young age with less physical and psychological maturity [1]. Hormone levels may be a factor in irregular menstruation. Both hypothyroidism and hyperthyroidism are associated with change in concentrations of sex hormones in both sexes, ovulatory function in women [13]. The ovaries are directly impacted by thyroid hormones, which also indirectly interact with sex hormone-binding globulin. These gonadotropin deficiencies are consistent with findings of thyroid-ovarian disease in low-resource environments, suggesting subclinical PCOS loads [2,7]. The endocrinal profiles of adolescent girls with menstrual irregularities are summarized that thyroid dysfunction (7.38%), biochemical hyperandrogenism (14.91%), and hyperprolactinemia (1.20%) were presented [32]. Family income levels associated with menstruation irregularity. Low income was found to be a proxy for unmet menstrual hygiene needs in Africa due to heavy menstrual bleeding. Due to delayed care-seeking and nutritional deficiencies, economic constraints probably exacerbate cycle disturbances [33,34].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are significant limitations to this cross-sectional, hospital-based investigation. Its architecture makes it impossible to prove causation for related variables. Due to symptomatic bias, selection and convenience sampling at KAAH Hospital may overstate prevalence (85.76%), limiting generalizability to Somaliland\u0026apos;s rural or community populations. Despite cultural precautions, self-reported data is susceptible to recollection and stigma-related biases. Multivariate models are required. Only subsets were covered by the lab data, and the timeframe of March\u0026ndash;May 2025 might be influenced by seasonal factors like Ramadan.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reveals a startling 85.76% prevalence of monthly irregularities among reproductive-age women at KAAH Hospital, Hargeisa. These irregularities are caused by a number of factors, including age (25\u0026ndash;29 peak), low income, hormonal disturbances (low FSH/LH), stress/anxiety, poor food, and sleep deficits, by providing a more holistic understanding of menstrual health that encompassed both psychosocial and biological health domains applicable to this population. In order to reduce long-term risks including infertility and metabolic disorders, identification of abnormal menstrual patterns that combine gynaecological, mental, and nutritional care may permit early detection of potential health problems and holistic interventions. Gender equity and well-being will be advanced by investing in Somaliland\u0026apos;s health systems, which will empower women. Start educating the community on ovulatory awareness and sanitary access through schools and mosques, focusing on low-income individuals (less than $100 per month) and those aged 25 to 29.\u003c/p\u003e\n\u003cp\u003eFuture studies should test nutritional supplements (vitamin A-rich therapies) for high-risk categories or use longitudinal designs to monitor FGM/C-sleep correlations. Multivariate regression, experimental supplements and counselling in post-conflict settings, and representative samples should all be included in future long-term studies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAUB: Abnormal Uterine Bleeding; BMI: Body Mass Index; CVD: Cardiovascular Disease; DM: Diabetes Mellitus; FGM/C: Female Genital Mutilation/Cutting; FSH: Follicle-Stimulating Hormone; FT3: Free Triiodothyronine; FT4: Free Thyroxine; GAD-7: Generalized Anxiety Disorder-7; GnRH: Gonadotropin-Releasing Hormone; HPA: Hypothalamic-Pituitary-Adrenal; HPO: Hypothalamic-Pituitary-Ovarian; IRB: Institutional Review Board; LH: Luteinizing \u0026nbsp;Hormone; MMR: Maternal Mortality Ratio; PCOS: Polycystic Ovary Syndrome; PSS: Perceived Stress Scale; SDG: Sustainable Development Goal; SLHDS: Somaliland Health and Demographic Survey; TSH: Thyroid-Stimulating Hormone; WHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the Hargeisa women who took part in this study and shared their experiences in spite of cultural concerns. We would especially want to thank the outpatient clinic staff and the administration of KAAH Hospital for providing support and their steadfast assistance in recruiting participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnder AI\u0026apos;s supervision, RA and HA planned the study, created the methodology, gathered and examined data, and wrote the first draft of the manuscript. PG oversaw data analysis, contributed to result interpretation, offered professional advice on study design, and critically edited the paper for intellectual substance and publishing preparation. Each author agreed to take responsibility for the accuracy and integrity of the work and contributed to the final manuscript approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work has not received any funding to support this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used and analysed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was secured from the appropriate Institutional Review Board (IRB) of KAAH Hospital. Informed consent had been obtained from all participants after explaining the study\u0026apos;s purpose, confidentiality, and voluntary nature. Prior to enrolment, informed consent was obtained from the parents or legal guardians of participants under the age of 16 (i.e., 15-year-olds), in addition to verbal assent from the individuals themselves when possible. All participants gave their informed consent after being informed in Somali or English of the study\u0026apos;s goals, methods, risks, and advantages; low-literate women gave their verbal approval. Participants could leave at any moment without having an impact on care. Anonymized data storage, password-protected digital entry, and limited access to the study team were all used to guarantee confidentiality. There were no rewards offered to prevent coercion. After publication, data will be kept for five years for auditing purposes before being safely destroyed. This inquiry adhered to the Declaration of Helsinki\u0026apos;s requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eUndergraduate student of Bachelor Medical Laboratory, Edna Adan University, Hargeisa, Somaliland\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eUndergraduate student of Bachelor Medical Laboratory, Edna Adan University, Hargeisa, Somaliland\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Master Public Health, Edna Adan University, Hargeisa, Somaliland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eDean of Medical Laboratory Sciences, Edna Adan University, Hargeisa, Somaliland\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eEshetu N, Abebe H, Fikadu E. Premenstrual syndrome, coping mechanisms and associated factors among Wolkite university female regular students, Ethiopia, 2021. \u003cem\u003eBMC Women\u0026rsquo;s Health\u003c/em\u003e, 2022; 22(88):1-11.\u003c/li\u003e\n \u003cli\u003eZeru AB, Gebeyaw ED, Ayele ET. Magnitude and associated factors of menstrual irregularity among undergraduate students of Debre Berhan University, Ethiopia. \u003cem\u003eReprod Health,\u0026nbsp;\u003c/em\u003e2021; 18(101):1-8.\u003c/li\u003e\n \u003cli\u003eKhan GA, Althubaiti A, Alshrif A. Dysmenorrhea, intermenstrual bleeding, menstrual flow volume changes, and irregularities following COVID-19 vaccination and the association with vaccine skepticism: a retrospective observational study. \u003cem\u003eWomen\u0026rsquo;s Health (Lond.),\u0026nbsp;\u003c/em\u003e2023; 19:1-9.\u003c/li\u003e\n \u003cli\u003eSong S, Choi H, Pang Y. Factors associated with regularity and length of menstrual cycle: Korea Nurses\u0026rsquo; Health Study. \u003cem\u003eBMC Women\u0026rsquo;s Health,\u0026nbsp;\u003c/em\u003e2022; 23(361):1-12.\u003c/li\u003e\n \u003cli\u003eGao F, Wei Z, He J. The relationship between menstrual issues and depressive and anxiety symptoms in Chinese adolescent female inpatients: a cross-sectional questionnaire-based investigation. \u003cem\u003eBMC Psychology,\u0026nbsp;\u003c/em\u003e2025; 13(675):1-10.\u003c/li\u003e\n \u003cli\u003eUkoaka BM, Abiodun AH, Daniel FM. The burden of menstrual irregularities among women living with HIV in Nigeria: a comprehensive review. \u003cem\u003eReprod Health,\u0026nbsp;\u003c/em\u003e2024; 21(156):1-14.\u003c/li\u003e\n \u003cli\u003eHussein N, Shiferaw K, Lonsako AA. Menstrual irregularity and associated factors among female adolescents in Somali region high schools Ethiopia 2023. \u003cem\u003eSci Rep\u003c/em\u003e, 2025; 15(1):1-10.\u003c/li\u003e\n \u003cli\u003eMittiku YM, Mekonen H, Wogie G. Menstrual irregularity and its associated factors among college students in Ethiopia, 2021. \u003cem\u003eFront Glob Womens Health,\u0026nbsp;\u003c/em\u003e2021; 3:1-9.\u003c/li\u003e\n \u003cli\u003eHarley KG, Watson A, Robertson S. Menstrual cycle characteristics of U.S. adolescents according to gynecological age and age at menarche. \u003cem\u003eJ Pediatr Adolesc Gynecol\u003c/em\u003e, 2024; 37(4):419-25.\u003c/li\u003e\n \u003cli\u003eEgal JA, Kiruja J, Litorp. Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria: a prospective cross-sectional study in a national referral hospital. \u003cem\u003eInt J Gynecol Obstet,\u0026nbsp;\u003c/em\u003e2022; 159:856-64.\u003c/li\u003e\n \u003cli\u003eMinistry of Planning and National Development. The Somaliland Health and Demographic Survey [eBook]\u003cem\u003e.\u003c/em\u003e Somaliland Government: UNFPA. 2020. Available from: https://www.google.com/url?sa=t\u0026amp;rct=j\u0026amp;q=\u0026amp;esrc=s\u0026amp;source=web\u0026amp;cd=\u0026amp;cad=rja\u0026amp;uact=8\u0026amp;ved=2ahUKEwjaz8_98sCEAxUOgP0HHT0VDNAQFnoECA4QAQ\u0026amp;url=https%3A%2F%2Fsomalia.unfpa.org%2Fsites%2Fdefault%2Ffiles%2Fpub-pdf%2Fslhds2020_report_2020.pdf\u0026amp;usg=AOvVaw2kRc8_BPXparJTqnB5-KYI\u0026amp;opi=89978449\u003c/li\u003e\n \u003cli\u003eAlemu BW, Waljer M, Tooth LR. The association between menstrual disorders and workforce participation: a prospective longitudinal. \u003cem\u003eBJOG,\u0026nbsp;\u003c/em\u003e2025; 132(7):961-71.\u003c/li\u003e\n \u003cli\u003eXiaoyang L, Yang H, Yan M. The mediating role of menstrual irregularity on obesity and sexual function in Chinese women with pelvic floor disorders: a cross-sectional study. \u003cem\u003eBMC Women\u0026rsquo;s Health,\u0026nbsp;\u003c/em\u003e2023; 23(462):1-9.\u003c/li\u003e\n \u003cli\u003eKiyak S, Bati S. The relationship between menstrual cycle pattern and post-traumatic stress in women following the 2023 earthquake in Turkey. \u003cem\u003eBrain Behav\u003c/em\u003e, 2024; 14(9):1-10.\u003c/li\u003e\n \u003cli\u003eAttia GM, Alharbi OA, Aljohani RM. The impact of irregular menstruation on health: a review of the literature. \u003cem\u003eCureus,\u0026nbsp;\u003c/em\u003e2023; 15(11):1-9.\u003c/li\u003e\n \u003cli\u003eMatsumura Y, Yamamoto R, Shinzawa M. Psychological and physical stress response and incidence of irregular menstruation in female university employees: a retrospective cohort study. \u003cem\u003eJ Epidemiol,\u0026nbsp;\u003c/em\u003e2025; 35(10):425-431.\u003c/li\u003e\n \u003cli\u003eAgbakwu CE, Fox KA, Thomas AB. Influence of female genital mutilation/cutting on health morbidity, health service utilization and satisfaction with care among Somali women and teenage girls in the United States. \u003cem\u003eJ Racial Ethn Health Disparities,\u0026nbsp;\u003c/em\u003e2022; 10(2):788-96.\u003c/li\u003e\n \u003cli\u003eMaregn RT, Bourret K, Egal JA. Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system. \u003cem\u003eBMJ Open,\u0026nbsp;\u003c/em\u003e2023; 13(3):1-8.\u003c/li\u003e\n \u003cli\u003eSawyer G, Howe LD, Abigail Fraser. Menstrual cycle features in mothers and daughters in the Avon Longitudinal Study of Parents and Children (ALSPAC). \u003cem\u003eWellcome Open Res,\u0026nbsp;\u003c/em\u003e2023; 8(386):1-47.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDas P, Jungari S. Prevalence, risk factors and health-seeking behavior of menstrual disorders among women in India: a review of two-decade evidence. \u003cem\u003eGlob Health Action,\u0026nbsp;\u003c/em\u003e2024; 17(1):1-11.\u003c/li\u003e\n \u003cli\u003eEva SK, Aufi SS, Mamun AS. Depression and its association with menstrual disturbance among female university students: a cross\u0026mdash;sectional study. \u003cem\u003eBMJ Public Health,\u0026nbsp;\u003c/em\u003e2024; 2(2):1-8.\u003c/li\u003e\n \u003cli\u003eAli AO, Abdi A, Egge A. Exploring the magnitude and determinants of ovulatory period knowledge among young women in Somalia: a multilevel analysis utilizing data from the 2020 Somali Health and Demographic Survey (SHDS). \u003cem\u003eDiscover Public Health,\u0026nbsp;\u003c/em\u003e2025; 22(498):1-16.\u003c/li\u003e\n \u003cli\u003eMadziyire MG, Magwali TL, Chikwasha V. The causes of infertility in women presenting to gynaecology clinics in Harare, Zimbabwe; a cross sectional study. \u003cem\u003eFertil Res Pract,\u0026nbsp;\u003c/em\u003e2021; 7(1):1-8.\u003c/li\u003e\n \u003cli\u003eWastila L, Fu YH, Tung CC. Association between vaccination for human papillomavirus (HPV) and autonomic dysfunction and menstrual irregularities: a self-controlled case series analysis. \u003cem\u003eDrugs Real World Outcomes,\u0026nbsp;\u003c/em\u003e2025; 12(3):467-77.\u003c/li\u003e\n \u003cli\u003eRavi S, Ihalainen JK, Mikkonen RS. Self-reported restrictive eating, eating disorders, menstrual dysfunction, and injuries in athletes competing at different levels and sports. \u003cem\u003eNutrients,\u0026nbsp;\u003c/em\u003e2021; 13(3275):1-11.\u003c/li\u003e\n \u003cli\u003eBhardwaj P, Yadav SK, Taneja J. Magnitude and associated factors of menstrual irregularity among young girls: a cross-sectional study during COVID-19 second wave in India. \u003cem\u003eJ Family Med Prim Care,\u0026nbsp;\u003c/em\u003e2022; 11(12):7769-75.\u003c/li\u003e\n \u003cli\u003eKucukerdem HS, Ozdemir TD. Evaluation of menstrual irregularities following COVID-19 infection or vaccination: the impact of COVID anxiety and associated risk factors. \u003cem\u003eMedicine,\u0026nbsp;\u003c/em\u003e2024; 103(26):1-6.\u003c/li\u003e\n \u003cli\u003eJung HN, Suh D, Jeong WC. Associations of chronotype and insomnia with menstrual problem in newly employed nurses at university hospitals in the Republic of Korea. \u003cem\u003eAnn Occup Environ Med,\u0026nbsp;\u003c/em\u003e2023; 35:1-13.\u003c/li\u003e\n \u003cli\u003eMiyamoto M, Hanatani Y, Shibuya K. Relationship among nutritional intake, anxiety, and menstrual irregularity in Elite Rowers. \u003cem\u003eNutrients,\u0026nbsp;\u003c/em\u003e2021; 13(3436):1-7.\u003c/li\u003e\n \u003cli\u003eSen LC, Jahan I, Salekin N. Food craving, vitamin A, and menstrual disorders: a comprehensive study on university female students. \u003cem\u003ePLoS One,\u003c/em\u003e 2024; 19(9):1-19.\u003c/li\u003e\n \u003cli\u003eMussa I, Jibro U, Balis B. Burden of irregular menstrual cycle and its predictors among reproductive-age women in Ethiopia: systematic review and meta-analysis. \u003cem\u003eSAGE Open Med,\u0026nbsp;\u003c/em\u003e2024; 12:1-12.\u003c/li\u003e\n \u003cli\u003ePatel S, Pushpalatha K, Singh B. Evaluation of hormonal profile and ovarian morphology among adolescent girls with menstrual irregularities in a tertiary care centre at Central India. \u003cem\u003eScientific World Journal,\u0026nbsp;\u003c/em\u003e2022; 3047526: 1-8.\u003c/li\u003e\n \u003cli\u003eMisra A, Wolfe O, Azziz R. The impact of childhood abuse and neglect on the development of features of polycystic ovary syndrome: a pilot study. \u003cem\u003eWomens Health Rep (New Rochelle),\u0026nbsp;\u003c/em\u003e2025; 6(1):412-20.\u003c/li\u003e\n \u003cli\u003eObeagu, Ifeanyi E. Prevalence and risk factors of heavy menstrual bleeding in Africa: a narrative review. \u003cem\u003eAnnals of Medicine \u0026amp; Surgery,\u0026nbsp;\u003c/em\u003e2025; 87(7):4194-4200.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Menstrual irregularities, reproductive-age women, Somaliland, Associated factors, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8436991/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8436991/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMenstrual irregularities defines as cycles shorter than 21 days, longer than 35 days, or varying more than 7 days, impacting 5-30% of reproductive-age women globally. In Somaliland, sociocultural taboos, restricted access to sanitary products, and inadequate health infrastructure worsen underreporting and unmet needs. This study determined prevalence and the characteristics of irregular menstruation among reproductive women who visit KAAH Hospital, Hargeisa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional hospital-based study design enrolled 288 women aged 15-49 years from March-May 2025, via convenience sampling. A standardized questionnaire captured sociodemographic, menstrual history, lifestyle, psychosocial measures (Perceived Stress Scale, Generalized Anxiety Disorder-7), and medical history (PCOS, thyroid). Hormonal assays (prolactin, TSH, LH, and FSH) were examined for possible instances. Bivariate analysis (chi-square tests) identified variables associated with irregular menstruation at a significance level of \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe frequency of irregular menstruation was 85.76%. Age (peak 25–29 years; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), income \u0026lt;$100 (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), hormonal imbalances (e.g., 24.61% low LH; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), stress (\u003cem\u003ep\u003c/em\u003e=0.039), anxiety (\u003cem\u003ep\u003c/em\u003e=0.018), an unhealthy diet (66.26%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), and less than seven hours of sleep per night (71.95%; \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). Low gonadotropins and thyroid problems (18.46% elevated TSH) suggested ovarian disturbances, maybe subclinical PCOS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn Somaliland, high incidence indicates the need for urgent integrated screening for hormonal, psychosocial, and lifestyle risks. Education, nutrition, and FGM/C mitigation are SDG 3/5-aligned treatments that could promote reproductive equity by preventing infertility, metabolic risks, and inequities.\u003c/p\u003e","manuscriptTitle":"Prevalence and Associated Factors of Menstrual Irregularities Among Reproductive-age Women Attending Kaah Hospital, Hargeisa, Somaliland: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-14 14:28:07","doi":"10.21203/rs.3.rs-8436991/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-06T12:09:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-05T22:23:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36387720045973147809462683574099618642","date":"2026-03-22T03:45:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206991066160209504529826481405808594631","date":"2026-02-21T19:45:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182531240609995883333106933886096110659","date":"2026-02-19T04:28:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-24T06:38:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20100481595967489791541615397822744574","date":"2026-01-18T05:30:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146536664838969521080753277962515297552","date":"2026-01-14T05:51:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-12T12:11:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-12T11:28:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-01T07:00:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-31T11:35:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-12-31T11:25:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2c53f557-37ce-4b2e-932c-b2dfedda7315","owner":[],"postedDate":"January 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T12:43:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-14 14:28:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8436991","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8436991","identity":"rs-8436991","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}