Effects of occupational noise exposure on menstrual abnormalities among female workers: a path analysis based on XGBoost and structural equation modeling

Occupational noise exposure is a prevalent occupational hazard. Although its adverse effects on hearing and the cardiovascular system are well documented, its impact on female reproductive health remains unclear. This study aimed to investigate the association between occupational noise exposure and menstrual abnormalities among female workers, as well as the underlying mechanisms. In 2024 and 2025, 1,108 female workers in Chongqing were enrolled. Univariate logistic regression was used to screen relevant variables, and the XGBoost algorithm was applied to identify key predictors. A structural equation model was constructed with daily occupational noise exposure as the independent variable and menstrual abnormalities as the dependent variable. Psychological distress was specified as a mediator, while hearing loss, sleep duration, noise sensitivity, and noise annoyance were specified as moderators of the relationship between noise exposure and psychological distress. A total of 334 participants (30.1%) experienced menstrual abnormalities. Univariate analysis showed that daily occupational noise exposure duration, noise sensitivity, and noise annoyance were positively associated with menstrual abnormalities ( P < 0.05). XGBoost identified use of hearing protection devices, age, and sleep duration as the most important predictors. The structural equation model demonstrated good fit. The total effect of noise exposure on menstrual abnormalities was significant ( β = 0.424, P = 0.006); after including the mediator, the direct effect became non-significant, while psychological distress significantly mediated this relationship (indirect effect = 0.243, P = 0.029), accounting for 57.3% of the total effect. Noise sensitivity, sleep duration, and hearing loss exerted significant moderating effects on the pathway from noise exposure to psychological distress. Occupational noise exposure affects menstrual status in female workers primarily through psychological distress. Use of earplugs/muffs and sleep duration are negatively associated with menstrual abnormalities, while age, psychological distress, and high noise annoyance are positively associated with them.