Nurse-led menstrual hygiene management package to improve menstrual health practices among university students: Randomised waitlist-controlled protocol study

BACKGROUND: Despite the cost, disposal issues, risk of infections and environmental burden, sanitary pads continue to be the most used method of menstrual hygiene among young women in India. Menstrual cups are a safer, cost-effective and environmentally friendly option, but acceptance is very low because of myths, cultural taboos and absence of organised education. There has been no randomised trial in Sikkim to assess a menstrual cup awareness and use promotion intervention. This study is designed to assess the effect of a Nurse-Led Menstrual Hygiene Management Package (NL-MHMP) on awareness, perception and sustained use of menstrual cups among university students. MATERIALS AND METHODS: A randomised active wait list-controlled trial will be conducted among 140 undergraduate female students (18–25 years) using proportionate stratified sampling technique from government and private universities in Gangtok, Sikkim and simple randomisation will be used to allocate participants into intervention and wait list groups. The NL-MHMP includes a 15-minute teaching session, audiovisual demonstration, graphical hand-out, clarification session, and the distribution of two ISO-certified menstrual cups with digital follow-up for six menstrual cycles. The primary outcome is sustained adoption of menstrual cup use among sanitary pad users. Secondary outcomes include changes in awareness, attitude, acceptability, adaptability, misconceptions, satisfaction, and preference toward menstrual cups. CONCLUSION: This nurse-led, digitally supported intervention offers a structured and scalable approach to improving menstrual health literacy and promoting sustainable menstrual hygiene practices among young women in Sikkim. Findings may inform university-based health programs and contribute to evidence-based policy initiatives supporting eco-friendly menstrual products. TRIAL REGISTRATION: The study is registered on 19/06/2025 in the Clinical Trial Registry India with trial ID: CTRI/2025/06/089117, prospectively registered.