Abnormal uterine bleeding, menstrual poverty and the financial burden of menstrual hygiene among Brazilian adolescents: A multicenter cross‐sectional study on health inequities

Abstract

OBJECTIVE: To describe menstrual period characteristics among Brazilian adolescents, focusing on menstrual patterns, use of sanitary products, and influence of socioeconomic conditions on menstrual health. METHODS: A multicenter cross-sectional study was conducted, including adolescents from all official sociodemographic regions of Brazil. The study evaluated menstrual cycle characteristics, usage patterns of menstrual products, and socioeconomic status (categorized A-E). There was also an analysis of the cost of sanitary pads and the resulting economic impact of these on household income. RESULTS: A total of 195 adolescents were included (mean age: 16.70 ± 1.99 years), with 20.51% reporting self-perceived abnormal uterine bleeding (AUB). Among those with AUB, 60% had irregular cycles and 30% reported bleeding duration exceeding eight days. Compared to those with normal bleeding, adolescents with AUB used significantly more menstrual products (p < 0.001), reported more intermenstrual bleeding (p = 0.001), and required frequent changes of underwear (p = 0.005), clothing (p = 0.006), and bedding (p = 0.005). Among those with AUB, 52.5% resided in the poorest regions (North/Northeast) and identified as Black or mixed-race (brown-skinned), facing greater barriers to healthcare. The number of pad/cycles was higher in the AUB-group (p = 0.015). The financial burden was substantial: participants from higher socioeconomic strata (A-B2) allocated only 0.05%-0.15% of their income to pads, whereas this proportion was nearly 20 times higher for groups D-E (1.66%). CONCLUSION: Brazilian adolescents exhibit a high prevalence of AUB, which correlates with increased hygiene product needs and a disproportionate financial burden. Addressing the link between socioeconomic inequity and period poverty is essential for public health.