Problematic menstrual symptoms are experienced by large proportions of people who menstruate and can have wide-reaching implications for health and wellbeing. Despite this, limited research has sought to understand their relationship with social disadvantage. In this thesis, I aim to examine the potential bidirectional association in three UK population-based longitudinal cohort studies. In this thesis, I detail current knowledge of menstrual symptoms, including risk factors and consequences, with a focus on socioeconomic position and childhood adversity, and highlight gaps in current literature (Chapter 1). Chapter 2 describes data sources and methods utilised to address my research questions. Chapter 3 presents a data note in which I curate available menstrual data in two generations from the Avon Longitudinal Study of Parents and Children. In Chapters 4 and 5, I examine associations between two aspects of social disadvantage (socioeconomic position and adverse childhood experiences, respectively) and menstrual symptoms in three cohorts. Notably, I find relatively consistent evidence that lower socioeconomic position is associated with menstrual-related pain, short or long cycle lengths, and irregular cycles. More exposure to adversity in childhood was also associated with menstrual pain and irregularity. There was inconsistent evidence for associations between both aspects of social disadvantage and heavy and prolonged bleeding across the cohorts. Chapter 6 presents analyses examining the association between adolescent menstrual-related pain and heavy or prolonged bleeding with educational outcomes in one of the cohorts. Both symptoms were associated with more school absences and lower attainment in compulsory qualifications, adjusting for various confounders. I summarise findings, examine strengths and limitations of this work, and highlight implications for future research and public health in Chapter 7. Overall, the results imply that menstrual symptoms may play a role in persistent social disadvantage and improvements in menstrual health education and management could contribute to reducing health inequalities.
Exploring bidirectional associations between social disadvantage and menstrual symptoms
Sawyer, G. R. (Author). 17 Mar 2026
Student thesis: Doctoral Thesis › Doctor of Philosophy (PhD)