Entebbe, Uganda, 25 April 2025 – A multi-component menstrual health intervention in Ugandan secondary schools led to modest gains in adolescents’ menstrual health, self‐efficacy and effective pain management but was not sufficient to enhance their mental health or educational performance, according to findings from a cluster randomised trial published yesterday in The Lancet Global Health.

The study, titled “Effects and costs of a multi-component menstrual health intervention (MENISCUS) on mental health problems, educational performance, and menstrual health in Ugandan secondary schools,” provides some of the first quantitative evidence on the wider impacts of a multi-component menstrual health intervention, amidst growing public interest and programming around menstrual health.

Conducted in 60 secondary schools in Wakiso and Kalungu districts, the MENISCUS trial evaluated whether improving menstrual experiences – through an intervention that included puberty education, training on menstrual health and hygiene, provision of reusable menstrual products, access to pain management strategies, and improvements to school toilet facilities – could enhance students’ wellbeing, school engagement, and mental health. Schools were randomly assigned to either the intervention group, which received the intervention immediately, or the control group, which received the intervention at the end of the study. The intervention was overseen by menstrual health “action groups” in each school. Over 3,000 students participated in the follow-up assessments after one year, completing a survey and an educational assessment set by the Uganda National Exam Board.

Students reported greater confidence in managing their menstruation and a more supportive school environment. However, improvements were modest, highlighting remaining unmet menstrual health needs. Study findings show that 75% of students used effective menstrual pain management methods in the intervention schools, compared with 67% in the control schools. There was also little evidence of an impact of the intervention on school attendance during menstruation. 

A key innovation of the intervention was its focus on the social environment, involving both girls and boys in puberty education sessions and drama skits to challenge stigma and foster a supportive school community. The researchers highlighted the importance of participant-centered interventions that aim to address menstrual needs and confidence, going beyond product provision and objectively defined measures of good menstrual hygiene management.

A student described the intervention’s impact on fostering inclusivity:

“From the drama skit, we learned that it is not right to laugh at a girl who has stained her dress but instead offer help. Also, I think the teachers have become more supportive rather than indifferent.” (Senior 2 Student)

Teachers also reported shifts in school policies, such as better access to pain management strategies:

“Before, if you needed pain medication, you had to leave school to get it.  After this intervention, school administrators and menstrual action group members realised it was better to have medicine available in school.  Their mindsets have changed.” (Teacher, Kalungu District)

Professor Helen Weiss, Principal Investigator of the study, stated the importance of menstrual health as a fundamental human rights issue:

“Menstrual health is not just about products or hygiene—it is about dignity, participation, and gender equality. Our study shows that while interventions improve menstrual experiences, we need to do more to address broader social and psychological barriers that limit girls’ full engagement in school.”

The MENISCUS trial is supported by the Joint Global Health Scheme with funding from the UK Foreign, Commonwealth and Development Office, the UKRI/ Medical Research Council, the UK Department of Health and Social Care through the National Institute of Health Research (NIHR) and Wellcome.

This study is part of the Unit’s Non-Communicable Diseases (NCDs) theme. Learn more about NCD research at the Unit 

Related links: MENISCUS Trial Video

About key scientists:
Prof Helen Weiss (Principal Investigator) is an epidemiologist at the London School of Hygiene and Tropical Medicine (LSHTM). Her research focuses on adolescent health, mental health, menstrual health and HIV epidemiology in low-income settings, and she is Director of the MRC International Statistics and Epidemiology Partnership | LSHTM.

Kate Nelson (Co-Investigator) is an epidemiologist at LSHTM, focusing on adolescent health, evaluation methods, and causal inference

Dr. Nambusi Kyegombe (Co–Investigator) is an interdisciplinary social scientist and jointly appointed as an Associate Professor in the social science of global and adolescent health and as head of social science at the MRC/UVRI & LSHTM Uganda Research Unit in Entebbe, Uganda where she leads a team of 60 inter-disciplinary social scientists.

Stephen Lagony (Trial Manager) is a health economist focusing on evaluating the cost and cost-effectiveness of health interventions in Uganda.

Denis Ndekezi is a public health specialist and a behavioral scientist at MRC/UVRI & LSHTM. His research efforts focus on health promotion, process evaluation of complex interventions and mixed methods research. 

About the Collaborating Institutions:
The Medical Research Council/Uganda Virus Institute/ London School of Hygiene & Tropical Medicine Uganda Research Unit (MRC/UVRI & LSHTM) is an internationally recognized center of excellence for research and training. Its mission is to conduct high-quality research that adds knowledge and leads to improved control of infectious and non-communicable diseases in Uganda, Africa and globally, through translation of scientific findings into policy and practice, and rigorous research capacity building.

The London School of Hygiene & Tropical Medicine (LSHTM) is one of the world's leading public health universities. Our vision is to help create a more healthy, sustainable and equitable world for everyone, because we believe our shared future depends on our shared health.

University College London (UCL) is a world-leading university recognized for excellence in research, innovation, education, and impact. Operating on a large scale , UCL consistently delivers outstanding academic performance. With a progressive approach to teaching and research, its renowned academics, inquisitive students, and dedicated staff push boundaries and drive solutions to real-world challenges.

WoMena is a dynamic, non-governmental organization that exists to challenge the lack of long-term strategies that support innovative reproductive health solutions. Composed of professionals in Public Health, Anthropology, Development, and Sociology, WoMena is dedicated to addressing social issues in Africa, with a focus on gender, reproductive health, and menstrual hygiene management. Through evidence-based interventions and advocacy, WoMena develops sustainable solutions that empower communities and improve health outcomes.