Prevalence and associated factors of menstrual irregularities among reproductive-age women attending KAAH hospital, Hargeisa, Somaliland: a cross-sectional study

Abstract

Menstrual irregularities are defined 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 the prevalence and characteristics of irregular menstruation among reproductive-age women who visited KAAH Hospital, Hargeisa. A cross-sectional hospital-based study design enrolled 288 women aged 15–49 years, who were attending the hospital from March-May 2025, via convenience sampling. A standardized questionnaire captured sociodemographic data, 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 in specific instances. Bivariate analysis (chi-square tests) identified variables associated with irregular menstruation at a significance level of p < 0.05. The frequency of irregular menstruation was 85.76% (247/288). Notable correlations were discovered with age (peak 25–29 years; p < 0.001), income <$100 (p = 0.021), hormonal imbalances (e.g., 24.61% low LH; p = 0.003), stress (p = 0.041), anxiety (p = 0.040), an unhealthy diet (66.26%; p < 0.001), and less than seven hours of sleep per night (71.95%; p < 0.001). Among the subgroup of laboratory results (n = 65), low gonadotropins (LH was 24.61% low) and thyroid problems (18.46% elevated TSH) suggested ovarian disturbances, possibly subclinical PCOS. 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.