A systematic review of knowledge, attitude, perception, burden, and impact of menstrual period on mental health and well-being of women of reproductive age in Nigeria

Menstrual health remains a neglected yet critical determinant of mental and physical well-being among women of reproductive age in resource-limited settings, including Nigeria, where persistent stigma, inadequate knowledge, and material deprivation converge to amplify vulnerability to psychological distress. This systematic review systematically mapped and thematically synthesized peer-reviewed evidence on the knowledge, attitudes, perceptions, burden, and mental health impact of menstruation among Nigerian women of reproductive age (15-49 years), identifying key gaps to inform policy, practice, and future research. A systematic search of PubMed, Scopus, AJOL, Springer, ScienceDirect, and Google Scholar was conducted for primary studies (cross-sectional, qualitative, mixed-methods, and quasi-experimental) published between January 2015 and December 2025. Findings were synthesized thematically. Twenty-eight studies met the inclusion criteria, spanning six geopolitical zones of Nigeria. Five overarching themes were identified: persistent knowledge deficits regarding menstrual physiology, especially in rural areas; prevailing negative attitudes, stigmatization, and cultural restrictions; high prevalence of menstrual disorders, particularly dysmenorrhea and premenstrual syndrome; substantial mental health burden, including depression, anxiety, low self-esteem, and social withdrawal; and marked educational disruption, with reporting school absenteeism during menstruation. The evidence reveals a cyclical relationship wherein inadequate knowledge fuels stigma, which in turn exacerbates psychological distress, educational disruption, and diminished quality of life. Despite growing policy recognition, fragmented data and limited geographical reach constrain generalizability. Rigorous longitudinal and interventional research is urgently needed to inform scalable, evidence-based solutions.