Menstrual health literacy in young women with severe menstrual pain in Germany

Background

Globally, menstrual pain affects more than 70% of women under 25 years and may lead to absenteeism from school and work. Severe menstrual pain is one of the early symptoms of endometriosis, yet there is still an average delay of up to 12 years until a confirmed endometriosis diagnosis. Poor menstrual health literacy likely contributes to this delay, but population-level data in affected young women remain scarce.

Methods

Between 2024 and 2025, the MeMaF study enrolled 3,417 girls and young women aged 16 to 24 years with recurrent (≥3 times in the past 6 months) severe menstrual pain (numerical rating scale ≥6/10) across Germany. At baseline, menstrual health literacy was assessed with 5 items using 5-point Likert scales covering, for example, knowledge about endometriosis, where to find cycle-related information, and when to seek medical care for menstrual symptoms.

Results

Menstrual health literacy showed potential for improvement across all items. Almost two-thirds (63%) of participants did not know when to seek medical care. While 49% reported knowing where to find cycle-related information, still 23% did not know where to look. Regarding endometriosis, the majority (39%) reported low knowledge. Additionally, pain normalization was relatively common, with 22% considering their menstrual pain normal, although 51% were certain it was not. Only 19% thought they could improve their menstrual health independently.

Conclusions

Despite being very affected, young women with severe menstrual pain showed surprisingly high gaps in menstrual health literacy. These findings point to an underserved population and have direct implications for the design of targeted (digital) public health interventions, which should prioritize guidance on help-seeking behavior, address the extent to which menstrual pain is normal, and build self-efficacy to empower women to actively manage their menstrual health.

Key messages

• The majority of young women with severe menstrual pain do not know when to see a doctor.

• A substantial proportion do not know where to find reliable information or that their pain is not normal.