Background: It is known that cyclic menstruation imposes significant burdens on a large portion of the female population with a plethora of symptoms, including pelvic pain, dysmenorrhea, menorrhagia, and psychological distress. The effects are widespread, impacting quality of life, ability to work and function, finances, and education. For the most part, previous studies have been surveys administered through social media channels such as pelvic pain and endometriosis societies, which, by definition, introduce bias. There is a need to evaluate the female population regarding female health issues in a less biased manner to assess the actual disease burden and response.

Methods: A cross-sectional, IRB-approved study of the Nova Southeastern University undergraduate and graduate female population cohort (2022) was conducted using a self-administered, anonymous survey to assess the prevalence of menstrual pain and disability (menstrual burden). This included the use of prescription and non-prescription medications, self-help interventions, and cannabis use (either medicinal or recreational) for symptoms associated with menstruation. All students who identify as female at the university were invited via campus email to participate in this survey, hosted securely on the SurveyMonkey website. One initial invitation was sent, followed by two reminder invitations at 2-week intervals. A descriptive analysis was performed.

Results: 14,024 email invitations were sent to the entire university population that identified as female to the registrar, with a response rate of 15.8% (similar to the response rate in most university surveys at this institution). 18.23% of the cohort reported bleeding that restricted the student’s ability to function, and 13.2% were so severely affected by menstrual symptoms that bed rest was required to cope adequately. Primary symptoms of bloating/swelling/constipation were reported in over 77%, mood swings/moodiness in approximately 74%, and pelvic or back pain was noted in over 70% of the respondents. In an assessment of treatment regimens, approximately 80% used over-the-counter medications, 55% reported using heating pads, 25% used oral contraceptives or hormonal management, 29.6% engaged in exercise or meditation, and fully 14.76% used cannabis in its various forms as treatment adjuncts (in addition to other regimens). In the evaluation of multiple efficacies, the respondents reported that 72% of those that used OTC medications for relief found them very or moderately effective, 66.2% of those that used a heating pad found it very or moderately effective, 54.2% of those that used exercise and meditation found it very or moderately effective, and cannabis was found to be very or moderately effective by 82% of the cohort that reported using it as an adjunct. Unexpectedly, there were some racial/ethnic differences in disease burden, the types of treatment modalities accessed, and perceived effectiveness. There were minimal differences between age groups.

Conclusion: Menstruation in female college students represents a significant challenge for 40.2% of this South Florida population, causing moderately severe to extremely severe symptoms. This study supports previous findings by Schoep on the impact of menstruation on the quality of life of Dutch women and by Munro’s global systematic review which documented a significant menstrual burden and its implications for education [2,3]. We found a high burden among college women when the entire female university population was invited to participate in this survey. This study’s emphasis on the menstrual burden and its impact on quality of life expands on previous studies. Our results should pave the way for a policy review of how the menstrual burden is approached in university settings, particularly regarding efforts to encourage gender equality.