*Corresponding Author: Gopal Anapana, Assistant Professor, Department of Zoology, Maharajah’s College
Autonomous, Vizianagaram, Andhra Pradesh, India., Email: [email protected]. 157
International Journal of Zoology and Applied Biosciences ISSN: 2455-9571
Volume 10, Issue 5, pp: 157-166, 2025 http://www.ijzab.com
https://doi.org/10.55126/ijzab.2025.v10.i05.018
Research Article
STRESS, SLEEP PATTERNS, AND REPRODUCTIVE HEALTH AMONG
FEMALE COLLEGE STUDENTS: EVIDENCE FROM A CROSS-SECTIONAL
STUDY IN VIZIANAGARAM, INDIA
*Gopal Anapana, D.S. Siva Ganesh, Komara Sruthi Kiran, Taddi Jhansi, Aravilli Harini,
Cheemala Shabari, Saripalli Dhanalaxmi, Pujari Sirivalli, Dunna Jhansi,
Rayithi Sankar, T. Seethamma
Department of Zoology, Maharajah’s College Autonomous, Vizianagaram, Andhra Pradesh, India.
Article History: Received 10th August 2025; Accepted 14th September 2025; Published 30th September 2025
ABSTRACT
This study investigated the interplay between stress, sleep quality, and reproductive health among female university
students in Vizianagaram, India, highlighting a substantial burden of interconnected health challenges. A cross-sectional
mixed-methods survey of 435 students aged 17–25 years revealed that 65% experienced high perceived stress, 45%
reported sleeping fewer than 6 hours per night, 30% faced menstrual irregularities, and 60% suffered from moderate-to-
severe dysmenorrhea. Both poor sleep and elevated stress were independently linked to adverse reproductive health
outcomes, while their combined effect amplified menstrual disturbances and pain through synergistic physiological
disruption. Despite moderate awareness of the impact of stress on hormonal health, nearly half of the students had never
consulted a gynaecologist, although 80% expressed willingness to use free counselling services. These findings emphasize
the urgent need for holistic, university-based interventions integrating stress management, sleep hygiene promotion, and
menstrual health education to safeguard student well-being and academic success.
Keywords: Stress, Sleep quality, Menstrual irregularity, Dysmenorrhea, Reproductive health.
INTRODUCTION
The transition to college presents a unique set of academic,
social, and lifestyle challenges for young women, often
resulting in elevated stress levels and disrupted sleep
patterns. Both factors have been independently linked to
adverse reproductive health outcomes, yet their combined
impact remains underexplored in student populations.
Chronic psychological stress activates the hypothalamic-
pituitary-adrenal (HPA) axis, increasing cortisol levels and
disrupting the hypothalamic-pituitary-ovarian (HPO) axis,
thereby impairing gonadotropin release and normal
ovulatory cycles (Shen et al., 2022). Similarly, sleep
disturbances, including reduced duration and poor quality,
have been associated with menstrual irregularities,
dysmenorrhea, and exacerbation of polycystic ovary
syndrome (PCOS) symptoms (Liu et al., 2023). Female
college students are particularly vulnerable to these risks
because of academic pressures, irregular schedules, and
lifestyle changes during early adulthood. The evidence
suggests that more than half of young women in higher
education systems experience menstrual irregularities,
many of which are linked to psychosocial stress and
inadequate sleep hygiene (Huang et al., 2021). The
bidirectional relationship between stress and sleep loss may
further amplify endocrine imbalances, worsening
reproductive health issues such as premenstrual syndrome
(PMS), amenorrhea, and hormonal fluctuations (Zhang et
al., 2024). These disturbances not only affect fertility
potential but also compromise physical and psychological
well-being. Polycystic ovary syndrome remains one of the
most common endocrine disorders among women of
reproductive age, affecting 8–13% of women globally, with
a higher prevalence among younger women in academic
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 158
environments (Bozdag et al., 2022). Stress and inadequate
sleep have been shown to exacerbate PCOS by
dysregulating the HPO axis and amplifying hormonal
imbalances (Zhou et al., 2023). Among university students,
greater perceived stress is correlated with menstrual
irregularities, PMS, and dysmenorrhea (Lee et al., 2023),
whereas sleep deprivation has been linked to irregular
cycles, greater bleeding, and luteal phase disruption (Musa
et al., 2022; Zhang et al., 2024). The interaction between
stress and poor sleep may therefore have a compound
effect, leading to more severe reproductive dysfunction
than either factor alone (Huang et al., 2021). In addition to
their biological effects, stress and sleep problems in young
women are closely associated with anxiety, depression,
body image concerns, and reduced academic performance
(Lee et al., 2023; Musa et al., 2022). These psychosocial
burdens may reinforce a cycle of poor health, as menstrual
disturbances and PCOS symptoms contribute to stigma,
underreporting, and delays in seeking care (Zhou et al.,
2023). Despite their prevalence, reproductive health
concerns are seldom prioritized in student health programs,
which often focus more on mental health and academic
stress than on their reproductive consequences. Lifestyle-
based interventions offer promising avenues for prevention
and management. Mindfulness, physical activity, dietary
modifications, and cognitive behavioural therapy have been
shown to improve stress resilience and menstrual health
outcomes (Lee et al., 2023; Musa et al., 2022). Similarly,
sleep hygiene practices, including consistent schedules,
limiting stimulants, and optimizing the sleep environment,
can enhance both sleep quality and reproductive function
(Liu et al., 2023). However, few studies have evaluated the
synergistic effects of stress and sleep quality on
reproductive health in a holistic manner, particularly in the
context of female college students. This gap underscores
the need for research that examines the integrated influence
of stress and sleep on reproductive health.
The present study addresses this need by investigating the
prevalence of menstrual irregularities and PCOS symptoms
among female college students in Vizianagaram, India, and
by evaluating how stress levels and sleep patterns
individually and jointly affect reproductive outcomes. It is
hypothesized that higher perceived stress levels are
significantly associated with menstrual irregularities,
including amenorrhea and dysmenorrhea, and that poorer
sleep quality and shorter sleep duration are significantly
linked to a greater prevalence and severity of PMS,
dysmenorrhea, and menstrual disturbances. Furthermore,
the synergistic presence of high stress and poor sleep
quality is expected to exert a stronger negative effect on
reproductive health markers than either factor alone. By
clarifying these associations, the study has academic,
clinical, and policy relevance. It empowers female students
to recognize early warning signs of hormonal and
menstrual disturbances and adopt preventive behaviours
while also informing universities about the need for
integrated health promotion programmes that include stress
reduction workshops, sleep hygiene education, and
reproductive health awareness campaigns. Given that
reproductive disturbances in early adulthood may
predispose women to long-term complications such as
infertility, metabolic syndrome, and cardiovascular risks,
early identification and intervention can yield significant
lifelong benefits. This work contributes to filling a critical
research gap and supports the promotion of holistic health
strategies in higher education settings.
MATERIALS AND METHODS
Study Design
This study employed a cross-sectional, survey-based
mixed-methods design to investigate the impact of stress
levels and sleep patterns on the reproductive health of
female college students. Both quantitative and qualitative
data were collected to provide a comprehensive
understanding of the physiological, psychological, and
lifestyle factors influencing reproductive outcomes. The
research was conducted between July 2024 and January
2025 across multiple departments of Maharajah’s
Autonomous College and its affiliated institutions.
Study Phases
The research was carried out in two phases. The first phase
involved a quantitative assessment, where structured
questionnaires and standardized scales were administered
to evaluate perceived stress, sleep quality, and reproductive
health indicators. Stress was measured via the Perceived
Stress Scale (PSS-10), whereas sleep quality was assessed
via the Pittsburgh Sleep Quality Index (PSQI).
Reproductive health data were obtained from self-reported
menstrual history, cycle regularity, severity of premenstrual
syndrome (PMS), dysmenorrhea, and prior diagnosis of
polycystic ovary syndrome (PCOS). Demographic and
lifestyle variables such as age, academic workload, dietary
habits, exercise frequency, body mass index (BMI), and
screen time were also recorded. The second phase focused
on qualitative exploration through open-ended survey
questions that captured students’ experiences related to
stress, sleep disturbances, menstrual health, barriers to
healthcare access, and coping strategies. These narratives
were thematically analysed to identify common challenges
and generate recommendations for targeted interventions.
Participants
The study population comprised female students aged 17--
25 years who were enrolled in undergraduate and
postgraduate programs. The participants were required to
provide informed consent before taking part in the study.
Students with a prior diagnosis of chronic hormonal
disorders unrelated to stress or sleep, such as thyroiditis or
adrenal disorders, or those receiving hormonal therapy
were excluded to minimize confounding influences. A
random stratified sampling method was adopted to ensure
representation across academic disciplines and year levels.
Recruitment was facilitated through institutional email,
WhatsApp academic groups, and on-campus awareness
drives, encouraging voluntary participation.
www.ijzab.com 158
environments (Bozdag et al., 2022). Stress and inadequate
sleep have been shown to exacerbate PCOS by
dysregulating the HPO axis and amplifying hormonal
imbalances (Zhou et al., 2023). Among university students,
greater perceived stress is correlated with menstrual
irregularities, PMS, and dysmenorrhea (Lee et al., 2023),
whereas sleep deprivation has been linked to irregular
cycles, greater bleeding, and luteal phase disruption (Musa
et al., 2022; Zhang et al., 2024). The interaction between
stress and poor sleep may therefore have a compound
effect, leading to more severe reproductive dysfunction
than either factor alone (Huang et al., 2021). In addition to
their biological effects, stress and sleep problems in young
women are closely associated with anxiety, depression,
body image concerns, and reduced academic performance
(Lee et al., 2023; Musa et al., 2022). These psychosocial
burdens may reinforce a cycle of poor health, as menstrual
disturbances and PCOS symptoms contribute to stigma,
underreporting, and delays in seeking care (Zhou et al.,
2023). Despite their prevalence, reproductive health
concerns are seldom prioritized in student health programs,
which often focus more on mental health and academic
stress than on their reproductive consequences. Lifestyle-
based interventions offer promising avenues for prevention
and management. Mindfulness, physical activity, dietary
modifications, and cognitive behavioural therapy have been
shown to improve stress resilience and menstrual health
outcomes (Lee et al., 2023; Musa et al., 2022). Similarly,
sleep hygiene practices, including consistent schedules,
limiting stimulants, and optimizing the sleep environment,
can enhance both sleep quality and reproductive function
(Liu et al., 2023). However, few studies have evaluated the
synergistic effects of stress and sleep quality on
reproductive health in a holistic manner, particularly in the
context of female college students. This gap underscores
the need for research that examines the integrated influence
of stress and sleep on reproductive health.
The present study addresses this need by investigating the
prevalence of menstrual irregularities and PCOS symptoms
among female college students in Vizianagaram, India, and
by evaluating how stress levels and sleep patterns
individually and jointly affect reproductive outcomes. It is
hypothesized that higher perceived stress levels are
significantly associated with menstrual irregularities,
including amenorrhea and dysmenorrhea, and that poorer
sleep quality and shorter sleep duration are significantly
linked to a greater prevalence and severity of PMS,
dysmenorrhea, and menstrual disturbances. Furthermore,
the synergistic presence of high stress and poor sleep
quality is expected to exert a stronger negative effect on
reproductive health markers than either factor alone. By
clarifying these associations, the study has academic,
clinical, and policy relevance. It empowers female students
to recognize early warning signs of hormonal and
menstrual disturbances and adopt preventive behaviours
while also informing universities about the need for
integrated health promotion programmes that include stress
reduction workshops, sleep hygiene education, and
reproductive health awareness campaigns. Given that
reproductive disturbances in early adulthood may
predispose women to long-term complications such as
infertility, metabolic syndrome, and cardiovascular risks,
early identification and intervention can yield significant
lifelong benefits. This work contributes to filling a critical
research gap and supports the promotion of holistic health
strategies in higher education settings.
MATERIALS AND METHODS
Study Design
This study employed a cross-sectional, survey-based
mixed-methods design to investigate the impact of stress
levels and sleep patterns on the reproductive health of
female college students. Both quantitative and qualitative
data were collected to provide a comprehensive
understanding of the physiological, psychological, and
lifestyle factors influencing reproductive outcomes. The
research was conducted between July 2024 and January
2025 across multiple departments of Maharajah’s
Autonomous College and its affiliated institutions.
Study Phases
The research was carried out in two phases. The first phase
involved a quantitative assessment, where structured
questionnaires and standardized scales were administered
to evaluate perceived stress, sleep quality, and reproductive
health indicators. Stress was measured via the Perceived
Stress Scale (PSS-10), whereas sleep quality was assessed
via the Pittsburgh Sleep Quality Index (PSQI).
Reproductive health data were obtained from self-reported
menstrual history, cycle regularity, severity of premenstrual
syndrome (PMS), dysmenorrhea, and prior diagnosis of
polycystic ovary syndrome (PCOS). Demographic and
lifestyle variables such as age, academic workload, dietary
habits, exercise frequency, body mass index (BMI), and
screen time were also recorded. The second phase focused
on qualitative exploration through open-ended survey
questions that captured students’ experiences related to
stress, sleep disturbances, menstrual health, barriers to
healthcare access, and coping strategies. These narratives
were thematically analysed to identify common challenges
and generate recommendations for targeted interventions.
Participants
The study population comprised female students aged 17--
25 years who were enrolled in undergraduate and
postgraduate programs. The participants were required to
provide informed consent before taking part in the study.
Students with a prior diagnosis of chronic hormonal
disorders unrelated to stress or sleep, such as thyroiditis or
adrenal disorders, or those receiving hormonal therapy
were excluded to minimize confounding influences. A
random stratified sampling method was adopted to ensure
representation across academic disciplines and year levels.
Recruitment was facilitated through institutional email,
WhatsApp academic groups, and on-campus awareness
drives, encouraging voluntary participation.
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 159
Data collection procedure
Data were collected via a structured survey designed in
Google Forms, which was disseminated both online and
offline to maximize participation. Before beginning the
survey, the participants were briefed on the study
objectives, voluntary nature of participation, and
confidentiality protocols. The survey instrument consisted
of close-ended questions using Likert-scale items for stress,
sleep, and lifestyle metrics, along with open-ended
questions aimed at capturing personal experiences and
perceived connections between stress, sleep, and
reproductive health.
Data analysis
The quantitative data were analysed via descriptive
statistics, including means, standard deviations, and
frequency distributions, to summarize demographic
characteristics, stress levels, and sleep quality. Associations
between categorical variables such as stress levels and
menstrual irregularities were examined via chi-square tests,
whereas independent t tests were used to compare mean
scores between groups with differing stress and sleep
patterns. The Pearson’ correlation coefficient was used to
assess the relationships between lifestyle factors such as
sleep duration, exercise frequency, and BMI and
reproductive health outcomes. Qualitative data from open-
ended responses were subjected to thematic analysis to
identify recurring patterns, barriers to care, and coping
strategies related to stress and reproductive health. All
analyses were performed via SPSS version 26.0 and
Microsoft Excel.
RESULTS AND DISCUSSION
A total of 435 female college students participated in the
study, with the majority aged 18–20 years (60%), followed
by 21–24 years (35%), and a smaller proportion aged 16–
18 years (5%) (Table 1). Academic representation was
diverse, with sciences (30.1%) and arts (25.1%) being the
most common fields, whereas residences were evenly
distributed between on-campus dormitories (50.1%) and
other living arrangements. Most participants fell within the
normal BMI range (65.1%), although 25% were overweight
or obese (Figure 4). These baseline demographics confirm a
representative sample of a young, urban, student population
similar to that reported in cross-sectional studies across
South Asia (Maheshwari et al., 2021).
Table 1. Demographic and academic characteristics of the participants (n = 435).
Variable Category n (%)
Age group 16–18 years 22 (5.0)
18–20 years 261 (60.0)
21–24 years 152 (35.0)
Field of study Sciences 131 (30.1)
Arts 109 (25.1)
Business 87 (20.0)
Engineering 65 (14.9)
Other 43 (9.9)
Residence On-campus dormitory 218 (50.1)
With family 131 (30.1)
Private hostel 86 (19.8)
BMI category Underweight (<18.5) 44 (10.1)
Normal (18.5–24.9) 283 (65.1)
Overweight (25–29.9) 87 (20.0)
Obese (≥30) 21 (4.8)
Menstrual health analysis revealed that 30% of the
participants experienced irregular cycles (<21 or >35 days),
with the majority maintaining 21–28-day cycles (40%)
(Table 2; Figure 5). Dysmenorrhea was common, with 60%
reporting moderate to severe pain (Figure 6). These
findings align with those of Eldeeb et al. (2022), who
reported menstrual irregularities in 25-35% of university
students, and are consistent with those of Liu et al. (2023),
who linked shorter sleep duration to greater odds of severe
menstrual pain. Conversely, lower rates of dysmenorrhea
(40–45%) have been reported among European cohorts
(Meczekalski et al., 2020), suggesting that cultural and
lifestyle differences may exacerbate menstrual symptoms in
Indian students.
Table 2. Menstrual cycle patterns and related symptoms.
Variable Category n (%)
Cycle length <21 days 65 (15.0)
21–28 days 174 (40.0)
29–35 days 65 (15.0)
>35 days 131 (30.0)
www.ijzab.com 159
Data collection procedure
Data were collected via a structured survey designed in
Google Forms, which was disseminated both online and
offline to maximize participation. Before beginning the
survey, the participants were briefed on the study
objectives, voluntary nature of participation, and
confidentiality protocols. The survey instrument consisted
of close-ended questions using Likert-scale items for stress,
sleep, and lifestyle metrics, along with open-ended
questions aimed at capturing personal experiences and
perceived connections between stress, sleep, and
reproductive health.
Data analysis
The quantitative data were analysed via descriptive
statistics, including means, standard deviations, and
frequency distributions, to summarize demographic
characteristics, stress levels, and sleep quality. Associations
between categorical variables such as stress levels and
menstrual irregularities were examined via chi-square tests,
whereas independent t tests were used to compare mean
scores between groups with differing stress and sleep
patterns. The Pearson’ correlation coefficient was used to
assess the relationships between lifestyle factors such as
sleep duration, exercise frequency, and BMI and
reproductive health outcomes. Qualitative data from open-
ended responses were subjected to thematic analysis to
identify recurring patterns, barriers to care, and coping
strategies related to stress and reproductive health. All
analyses were performed via SPSS version 26.0 and
Microsoft Excel.
RESULTS AND DISCUSSION
A total of 435 female college students participated in the
study, with the majority aged 18–20 years (60%), followed
by 21–24 years (35%), and a smaller proportion aged 16–
18 years (5%) (Table 1). Academic representation was
diverse, with sciences (30.1%) and arts (25.1%) being the
most common fields, whereas residences were evenly
distributed between on-campus dormitories (50.1%) and
other living arrangements. Most participants fell within the
normal BMI range (65.1%), although 25% were overweight
or obese (Figure 4). These baseline demographics confirm a
representative sample of a young, urban, student population
similar to that reported in cross-sectional studies across
South Asia (Maheshwari et al., 2021).
Table 1. Demographic and academic characteristics of the participants (n = 435).
Variable Category n (%)
Age group 16–18 years 22 (5.0)
18–20 years 261 (60.0)
21–24 years 152 (35.0)
Field of study Sciences 131 (30.1)
Arts 109 (25.1)
Business 87 (20.0)
Engineering 65 (14.9)
Other 43 (9.9)
Residence On-campus dormitory 218 (50.1)
With family 131 (30.1)
Private hostel 86 (19.8)
BMI category Underweight (<18.5) 44 (10.1)
Normal (18.5–24.9) 283 (65.1)
Overweight (25–29.9) 87 (20.0)
Obese (≥30) 21 (4.8)
Menstrual health analysis revealed that 30% of the
participants experienced irregular cycles (<21 or >35 days),
with the majority maintaining 21–28-day cycles (40%)
(Table 2; Figure 5). Dysmenorrhea was common, with 60%
reporting moderate to severe pain (Figure 6). These
findings align with those of Eldeeb et al. (2022), who
reported menstrual irregularities in 25-35% of university
students, and are consistent with those of Liu et al. (2023),
who linked shorter sleep duration to greater odds of severe
menstrual pain. Conversely, lower rates of dysmenorrhea
(40–45%) have been reported among European cohorts
(Meczekalski et al., 2020), suggesting that cultural and
lifestyle differences may exacerbate menstrual symptoms in
Indian students.
Table 2. Menstrual cycle patterns and related symptoms.
Variable Category n (%)
Cycle length <21 days 65 (15.0)
21–28 days 174 (40.0)
29–35 days 65 (15.0)
>35 days 131 (30.0)
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 160
Period pain severity None 87 (20.0)
Mild 87 (20.0)
Moderate 152 (35.0)
Severe 109 (25.0)
Hormonal symptoms Hair loss/skin changes 109 (25.0)
Menstrual migraines Yes/sometimes 174 (40.0)
Sleep quality was poor for a substantial proportion of
participants. Nearly one-third reported sleeping less than 6
hours per night, and 60% experienced difficulty initiating
sleep sometimes or often (Table 3; Figure 9). Although
70% had never used sleep medication, 15% reported
occasional or regular use, and another 15% had considered
it (Figure 10). These sleep-related difficulties mirror the
findings of Zhao et al. (2022), who demonstrated that
circadian rhythm disruption can worsen hormonal and
reproductive health. Our results suggest that poor sleep
may exacerbate menstrual pain, with poor sleepers being
more likely to report severe dysmenorrhea, confirming
earlier observations by Liu et al. (2023).
Table 3. Sleep-related characteristics.
Variable Category n (%)
Average sleep hours/night <6 hours 131 (30.1)
6–8 hours 218 (50.1)
>8 hours 86 (19.8)
Difficulty falling asleep Never 87 (20.0)
Rarely 87 (20.0)
Sometimes 174 (40.0)
Often 87 (20.0)
Sleep medication use Never 305 (70.1)
Occasionally 65 (15.0)
Regularly 22 (5.0)
Considered 43 (9.9)
The stress levels were remarkably high, with 65% of the
participants scoring 4–5 on the Perceived Stress Scale and
an average score of 3.8 ± 0. X (Table 4; Figure 11).
Academic workload and examinations were the dominant
stressors (75%) (Figure 2), followed by career concerns
(40%) and financial worries (30%). Coping mechanisms
were diverse, with social support (70%) and hobbies (60%)
being common, but maladaptive behaviours such as
comfort eating (40%) and procrastination (30%) were also
evident (Figure 12). These results are consistent with those
of Baharudin et al. (2021), who reported that students with
high perceived stress were 2.8 times more likely to
experience menstrual irregularities, and with those of Wu et
al. (2021), who proposed the synergistic stress sleep
hypothesis. Our findings further support this hypothesis, as
high-stress participants with poor sleep experienced a
threefold increase in menstrual irregularities (45% vs. 15%)
(Figure 16).
Table 4. Academic stress and coping strategies.
Variable Category n (%)
Primary stressor Academic workload/exams 326 (75.0)
Career concerns 174 (40.0)
Financial worries 131 (30.0)
Coping mechanism Talking to friends/family 305 (70.1)
Hobbies 261 (60.0)
Comfort eating 174 (40.0)
Procrastination 131 (30.0)
Exercise 51 (11.7)
Meditation 179 (41.2)
www.ijzab.com 160
Period pain severity None 87 (20.0)
Mild 87 (20.0)
Moderate 152 (35.0)
Severe 109 (25.0)
Hormonal symptoms Hair loss/skin changes 109 (25.0)
Menstrual migraines Yes/sometimes 174 (40.0)
Sleep quality was poor for a substantial proportion of
participants. Nearly one-third reported sleeping less than 6
hours per night, and 60% experienced difficulty initiating
sleep sometimes or often (Table 3; Figure 9). Although
70% had never used sleep medication, 15% reported
occasional or regular use, and another 15% had considered
it (Figure 10). These sleep-related difficulties mirror the
findings of Zhao et al. (2022), who demonstrated that
circadian rhythm disruption can worsen hormonal and
reproductive health. Our results suggest that poor sleep
may exacerbate menstrual pain, with poor sleepers being
more likely to report severe dysmenorrhea, confirming
earlier observations by Liu et al. (2023).
Table 3. Sleep-related characteristics.
Variable Category n (%)
Average sleep hours/night <6 hours 131 (30.1)
6–8 hours 218 (50.1)
>8 hours 86 (19.8)
Difficulty falling asleep Never 87 (20.0)
Rarely 87 (20.0)
Sometimes 174 (40.0)
Often 87 (20.0)
Sleep medication use Never 305 (70.1)
Occasionally 65 (15.0)
Regularly 22 (5.0)
Considered 43 (9.9)
The stress levels were remarkably high, with 65% of the
participants scoring 4–5 on the Perceived Stress Scale and
an average score of 3.8 ± 0. X (Table 4; Figure 11).
Academic workload and examinations were the dominant
stressors (75%) (Figure 2), followed by career concerns
(40%) and financial worries (30%). Coping mechanisms
were diverse, with social support (70%) and hobbies (60%)
being common, but maladaptive behaviours such as
comfort eating (40%) and procrastination (30%) were also
evident (Figure 12). These results are consistent with those
of Baharudin et al. (2021), who reported that students with
high perceived stress were 2.8 times more likely to
experience menstrual irregularities, and with those of Wu et
al. (2021), who proposed the synergistic stress sleep
hypothesis. Our findings further support this hypothesis, as
high-stress participants with poor sleep experienced a
threefold increase in menstrual irregularities (45% vs. 15%)
(Figure 16).
Table 4. Academic stress and coping strategies.
Variable Category n (%)
Primary stressor Academic workload/exams 326 (75.0)
Career concerns 174 (40.0)
Financial worries 131 (30.0)
Coping mechanism Talking to friends/family 305 (70.1)
Hobbies 261 (60.0)
Comfort eating 174 (40.0)
Procrastination 131 (30.0)
Exercise 51 (11.7)
Meditation 179 (41.2)
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 161
Psychological well-being indicators showed trends: 34.7%
reported depressive symptoms, 30.2% admitted to thoughts
of self-harm, and 35% reported some degree of social
isolation. Healthcare utilization was low, with 45% never
having visited a gynaecologist and 35% only visiting when
problems arose. These trends are consistent with those
reported by Goyal et al. (2022), who highlighted barriers
such as stigma and normalization of symptoms in Indian
student populations, but contrast with those reported by
Tsai et al. (2022), who reported greater healthcare
utilization in East Asian universities following structured
health campaigns. Encouragingly, 80% of the participants
indicated a willingness to attend free counselling sessions if
offered, underscoring the potential impact of institutional
interventions. Lifestyle analysis revealed high social media
engagement, with 40% spending ≥5 hours/day and 30%
spending 3–4 hours/day (Figure 14). More than half
(53.6%) perceived social media as having a negative
influence on stress (Figure 15). These findings echo reports
by Kumar et al. (2023), who documented the association
between digital overuse and psychological distress among
Indian students, but contrast with studies in Western
populations where moderate social media use was found to
foster social connectedness (Chan et al., 2021).
Taken together, these findings demonstrate strong
associations between stress, poor sleep, and reproductive
health disturbances. Our data align with the biological
framework described by Meczekalski et al. (2020),
whereby chronic stress and sleep deprivation dysregulate
the hypothalamic–pituitary–ovarian axis. The synergistic
effects of combined stress and poor sleep reinforce the need
for integrated interventions. Policy implications include the
implementation of campus-based wellness programs that
address stress management, sleep hygiene, and menstrual
health literacy simultaneously. Evidence from randomized
controlled trials (Chan et al., 2021) shows that
mindfulness-based stress reduction can improve both
psychological and reproductive health outcomes. The
strengths of this study lie in its large sample size (n = 435)
and mixed-methods design, which enabled quantitative
analysis and qualitative insights. However, reliance on self-
reported measures may have introduced recall bias, and the
cross-sectional nature limits causal inference. Longitudinal
and interventional studies are needed to clarify the temporal
relationships between stress, sleep, and reproductive health.
Nonetheless, the present findings contribute valuable
evidence supporting the urgent need for institutional-level
strategies to safeguard the reproductive and mental health
of female college students in India.
Figure 1. Reported Menstrual Cycle Length Distribution.
30% of students reported irregular menstrual cycles (<21
days or >35 days), whereas 40% reported cycles of 21–28
days.
Figure 2. Primary Sources of Student Stress.
Academic workload/exams were the most cited stressor
(75%), followed by future career concerns (40%) and
financial issues (30%).
www.ijzab.com 161
Psychological well-being indicators showed trends: 34.7%
reported depressive symptoms, 30.2% admitted to thoughts
of self-harm, and 35% reported some degree of social
isolation. Healthcare utilization was low, with 45% never
having visited a gynaecologist and 35% only visiting when
problems arose. These trends are consistent with those
reported by Goyal et al. (2022), who highlighted barriers
such as stigma and normalization of symptoms in Indian
student populations, but contrast with those reported by
Tsai et al. (2022), who reported greater healthcare
utilization in East Asian universities following structured
health campaigns. Encouragingly, 80% of the participants
indicated a willingness to attend free counselling sessions if
offered, underscoring the potential impact of institutional
interventions. Lifestyle analysis revealed high social media
engagement, with 40% spending ≥5 hours/day and 30%
spending 3–4 hours/day (Figure 14). More than half
(53.6%) perceived social media as having a negative
influence on stress (Figure 15). These findings echo reports
by Kumar et al. (2023), who documented the association
between digital overuse and psychological distress among
Indian students, but contrast with studies in Western
populations where moderate social media use was found to
foster social connectedness (Chan et al., 2021).
Taken together, these findings demonstrate strong
associations between stress, poor sleep, and reproductive
health disturbances. Our data align with the biological
framework described by Meczekalski et al. (2020),
whereby chronic stress and sleep deprivation dysregulate
the hypothalamic–pituitary–ovarian axis. The synergistic
effects of combined stress and poor sleep reinforce the need
for integrated interventions. Policy implications include the
implementation of campus-based wellness programs that
address stress management, sleep hygiene, and menstrual
health literacy simultaneously. Evidence from randomized
controlled trials (Chan et al., 2021) shows that
mindfulness-based stress reduction can improve both
psychological and reproductive health outcomes. The
strengths of this study lie in its large sample size (n = 435)
and mixed-methods design, which enabled quantitative
analysis and qualitative insights. However, reliance on self-
reported measures may have introduced recall bias, and the
cross-sectional nature limits causal inference. Longitudinal
and interventional studies are needed to clarify the temporal
relationships between stress, sleep, and reproductive health.
Nonetheless, the present findings contribute valuable
evidence supporting the urgent need for institutional-level
strategies to safeguard the reproductive and mental health
of female college students in India.
Figure 1. Reported Menstrual Cycle Length Distribution.
30% of students reported irregular menstrual cycles (<21
days or >35 days), whereas 40% reported cycles of 21–28
days.
Figure 2. Primary Sources of Student Stress.
Academic workload/exams were the most cited stressor
(75%), followed by future career concerns (40%) and
financial issues (30%).
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 162
Figure 3. Residential Status of Respondents.
Half of the students (50%) lived in college-managed
dormitories, 30% with family, and 20% in private hostels.
Figure 4. BMI Distribution Among Respondents.
65% of students were within normal BMI range (18.5–
24.9), 10% underweight, and 25% overweight/obese.
Figure 5. Reported Menstrual Cycle Length (Detailed).
30% reported irregular cycles (<21 or >35 days), with 40%
reporting typical 21–28-day cycles.
Figure 6. Severity of Menstrual Pain/Discomfort.
60% experienced moderate (35%) to severe (25%) pain
affecting daily activities.
Figure 7. Hair, Skin, and Facial Hair Changes Noticed.
25% reported noticeable hair loss, facial hair growth, or
significant skin changes in the last 6 months, possibly
indicating hormonal imbalances.
Figure 8. Experience of Menstrual-Related Migraines or
Severe Headaches.
40% experienced migraines or severe headaches
regularly or sometimes during their periods.
www.ijzab.com 162
Figure 3. Residential Status of Respondents.
Half of the students (50%) lived in college-managed
dormitories, 30% with family, and 20% in private hostels.
Figure 4. BMI Distribution Among Respondents.
65% of students were within normal BMI range (18.5–
24.9), 10% underweight, and 25% overweight/obese.
Figure 5. Reported Menstrual Cycle Length (Detailed).
30% reported irregular cycles (<21 or >35 days), with 40%
reporting typical 21–28-day cycles.
Figure 6. Severity of Menstrual Pain/Discomfort.
60% experienced moderate (35%) to severe (25%) pain
affecting daily activities.
Figure 7. Hair, Skin, and Facial Hair Changes Noticed.
25% reported noticeable hair loss, facial hair growth, or
significant skin changes in the last 6 months, possibly
indicating hormonal imbalances.
Figure 8. Experience of Menstrual-Related Migraines or
Severe Headaches.
40% experienced migraines or severe headaches
regularly or sometimes during their periods.
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 163
Figure 9. Frequency of Difficulty Falling Asleep.
60% of students reported difficulty falling asleep either
sometimes (40%) or often (20%).
Figure 10. Use of Sleep Medication or Melatonin.
70% never used sleep aids; 15% used them occasionally
or regularly, and another 15% had considered using them.
Figure 11. Average Perceived Stress Levels (1–5 Scale).
Average stress score was 3.8/5, with 65% reporting high
stress (score 4–5).
Figure 12. Coping Mechanisms for Stress.
Common strategies included talking to friends/family
(70%) and hobbies (60%); less adaptive strategies
included comfort eating (40%) and procrastination
(30%).
Figure 13. Awareness That Irregular Sleep Can Cause
Health Problems.
65% were definitely aware and 25% possibly aware that
irregular sleep negatively impacts health, including
reproductive health.
Figure 14. Daily Social Media Usage.
40% used social media ≥5 hours daily; 30% used it 3–4
hours, indicating high engagement.
www.ijzab.com 163
Figure 9. Frequency of Difficulty Falling Asleep.
60% of students reported difficulty falling asleep either
sometimes (40%) or often (20%).
Figure 10. Use of Sleep Medication or Melatonin.
70% never used sleep aids; 15% used them occasionally
or regularly, and another 15% had considered using them.
Figure 11. Average Perceived Stress Levels (1–5 Scale).
Average stress score was 3.8/5, with 65% reporting high
stress (score 4–5).
Figure 12. Coping Mechanisms for Stress.
Common strategies included talking to friends/family
(70%) and hobbies (60%); less adaptive strategies
included comfort eating (40%) and procrastination
(30%).
Figure 13. Awareness That Irregular Sleep Can Cause
Health Problems.
65% were definitely aware and 25% possibly aware that
irregular sleep negatively impacts health, including
reproductive health.
Figure 14. Daily Social Media Usage.
40% used social media ≥5 hours daily; 30% used it 3–4
hours, indicating high engagement.
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 164
Figure 15. Perceived Impact of Social Media on Stress
Levels
45% reported a mostly negative impact on stress, 20%
reported a positive impact, and 35% reported no or mixed
impact.
Figure 16. Menstrual Irregularity Prevalence by
Perceived Stress Level
High stress students (score 4–5) reported 45% menstrual
irregularity versus 15% in low stress students.
Table 5. Summary of Survey Responses to Stress, Sleep, and Reproductive Health among Female University Students (n =
435).
Questionnaire Response Options Result (%)/Observation
Age Group 16–18, 18–20, 21–24 18–20: 60%, 21–24: 35%, 16–18: 5%
Field of Study Sciences, Arts, Business, Engineering,
Other
Sciences: 30%, Arts: 25%, Business: 20%,
Engineering: 15%, Other: 10%
Place of Residence On-campus dormitory, Private hostel,
With family
Dormitory: 50%, Family: 30%, Private hostel:
20%
BMI Category Underweight (<18.5), Normal (18.5–
24.9), Overweight/Obese (≥25)
Normal: 65%, Underweight: 10%,
Overweight/Obese: 25%
Menstrual Cycle Length <21 days, 21– 28 days, 29– 35 days,
>35 days
21– 28 days: 40%, Irregular (<21 or >35 days):
30%
Period Duration 3 days, 3– 5 days, >7 days 3–5 days: majority
Menstrual Pain None, Mild, Moderate, Severe Moderate: 35%, Severe: 25%, Mild/None: 40%
Menstrual-Related
Symptoms
Hair/skin changes, Migraines Hair/skin: 25%, Migraines: 40%
Average Sleep Hours <6, 6–8, >8 <6: 30%, 6–8: 50%, >8: 20%
Difficulty Falling Asleep Never, Rarely, Sometimes, often Sometimes: 40%, Often: 20%, Rarely/Never:
40%
Sleep Medication Use Never, Occasionally, Regularly,
Considered
Never: 70%, Occasionally: 15%, Regularly: 5%,
Considered: 10%
Perceived Stress (1–5
scale)
1–5 High stress (4–5): 65%, Average score: 3.8
Coping Mechanisms Talking to friends/family, Hobbies,
Meditation, Exercise, Comfort eating,
Procrastination
Friends/family: 70%, Hobbies: 60%, Meditation:
41%, Comfort eating: 40%, Procrastination:
30%, Exercise: 12%
Anxiety Before Exams Yes, No, maybe Yes: 34%, No: 43%, Maybe: 20%
Libido Changes Increased, Decreased, No change Some awareness: 60%, Not aware: 40%
Sleep/Stress Impact on
Menstrual Cycle
Yes, No, maybe High stress group: 45% irregular cycles, Low
stress group: 15%
Visits to Gynaecologist Regularly, Occasionally, never Never: 45%, Occasionally: 35%, Regularly: 20%
Awareness of Stress
Effects on Hormonal
Health
Yes, No, Not sure Yes: 32%, No: 40%, Not sure: 24%
Social Media Usage <3 h, 3–4 h, ≥5 h 3–4 h: 30%, ≥5 h: 40%
Impact of Social Media on Positive, Negative, No impact Negative: 54%, Positive: 27%, No impact: 15%
www.ijzab.com 164
Figure 15. Perceived Impact of Social Media on Stress
Levels
45% reported a mostly negative impact on stress, 20%
reported a positive impact, and 35% reported no or mixed
impact.
Figure 16. Menstrual Irregularity Prevalence by
Perceived Stress Level
High stress students (score 4–5) reported 45% menstrual
irregularity versus 15% in low stress students.
Table 5. Summary of Survey Responses to Stress, Sleep, and Reproductive Health among Female University Students (n =
435).
Questionnaire Response Options Result (%)/Observation
Age Group 16–18, 18–20, 21–24 18–20: 60%, 21–24: 35%, 16–18: 5%
Field of Study Sciences, Arts, Business, Engineering,
Other
Sciences: 30%, Arts: 25%, Business: 20%,
Engineering: 15%, Other: 10%
Place of Residence On-campus dormitory, Private hostel,
With family
Dormitory: 50%, Family: 30%, Private hostel:
20%
BMI Category Underweight (<18.5), Normal (18.5–
24.9), Overweight/Obese (≥25)
Normal: 65%, Underweight: 10%,
Overweight/Obese: 25%
Menstrual Cycle Length <21 days, 21– 28 days, 29– 35 days,
>35 days
21– 28 days: 40%, Irregular (<21 or >35 days):
30%
Period Duration 3 days, 3– 5 days, >7 days 3–5 days: majority
Menstrual Pain None, Mild, Moderate, Severe Moderate: 35%, Severe: 25%, Mild/None: 40%
Menstrual-Related
Symptoms
Hair/skin changes, Migraines Hair/skin: 25%, Migraines: 40%
Average Sleep Hours <6, 6–8, >8 <6: 30%, 6–8: 50%, >8: 20%
Difficulty Falling Asleep Never, Rarely, Sometimes, often Sometimes: 40%, Often: 20%, Rarely/Never:
40%
Sleep Medication Use Never, Occasionally, Regularly,
Considered
Never: 70%, Occasionally: 15%, Regularly: 5%,
Considered: 10%
Perceived Stress (1–5
scale)
1–5 High stress (4–5): 65%, Average score: 3.8
Coping Mechanisms Talking to friends/family, Hobbies,
Meditation, Exercise, Comfort eating,
Procrastination
Friends/family: 70%, Hobbies: 60%, Meditation:
41%, Comfort eating: 40%, Procrastination:
30%, Exercise: 12%
Anxiety Before Exams Yes, No, maybe Yes: 34%, No: 43%, Maybe: 20%
Libido Changes Increased, Decreased, No change Some awareness: 60%, Not aware: 40%
Sleep/Stress Impact on
Menstrual Cycle
Yes, No, maybe High stress group: 45% irregular cycles, Low
stress group: 15%
Visits to Gynaecologist Regularly, Occasionally, never Never: 45%, Occasionally: 35%, Regularly: 20%
Awareness of Stress
Effects on Hormonal
Health
Yes, No, Not sure Yes: 32%, No: 40%, Not sure: 24%
Social Media Usage <3 h, 3–4 h, ≥5 h 3–4 h: 30%, ≥5 h: 40%
Impact of Social Media on Positive, Negative, No impact Negative: 54%, Positive: 27%, No impact: 15%
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 165
Stress
Work-Life Balance
Importance
1 (low) – 5 (high) Scores 4–5: 27%, Scores 1–3: 73%
Stress-Reduction Activities Exercise, Meditation, Hobbies,
Socializing
Meditation: 41%, Hobbies: 32%, Exercise: 12%,
Socializing: 10%
Willingness to Use Free
Counselling
Yes, No, Maybe Yes: 34%, No: 42%, Maybe: 20%
Peer Support for Stress 1 (low) – 5 (high) 3–5: 50%, 1–2: 46%
Primary Source of Stress Open text Academic pressure
Experience of Low
Mood/Depression
Yes, No, Not sure Yes: 35%, No: 42%, Not sure: 20%
Thoughts of Self-Harm Yes, No, Maybe Yes: 30%, No: 47%, Maybe: 19%
Feeling Connected Very connected, Somewhat connected,
Somewhat isolated, Very isolated
Very/somewhat connected: 61%,
Somewhat/very isolated: 35%
Menstrual Hygiene
Awareness
Yes completely, Yes partially, No Fully aware: 40%, Partial/No: 60%
Notes: Percentages may not sum to 100% owing to rounding or multiple responses. Observations summarize patterns in
the data where applicable.
CONCLUSION
This study underscores the considerable and interconnected
health challenges faced by female university students, with
high levels of perceived stress, poor sleep quality, and
dysmenorrhea emerging as prominent concerns. These
findings reveal that stress and sleep deprivation not only
individually impair reproductive health but also interact
synergistically to exacerbate menstrual irregularities and
pain through disruptions in the hypothalamic–pituitary–
ovarian axis. Despite moderate awareness of the impact of
stress on hormonal health, health-seeking behaviors remain
limited, with many students refraining from consulting
medical professionals. At the same time, the majority
expressed openness to free counselling services,
highlighting a critical opportunity for institutions to
strengthen student support systems. By addressing
psychosocial stressors, promoting menstrual health literacy,
and fostering accessible, stigma-free healthcare pathways,
universities can help mitigate these burdens and enhance
the overall well-being and academic success of their
students.
ACKNOWLEDGEMENT
The research team sincerely acknowledges the support
provided by the Department of Zoology at Maharajah’s
Autonomous College, Vizianagaram. We are deeply
grateful to the students who participated in the survey.
Their candid responses and willingness to share personal
experiences made it possible to examine the lived realities
of young women managing menstrual irregularities. Special
thanks are also extended to the educational institutions in
Vizianagaram that facilitated data collection and
encouraged student-centered research initiatives. Their
collaboration reflects a strong commitment to fostering
undergraduate scholarships and inquiry.
CONFLICT OF INTERESTS
The authors declare no conflicts of interest.
ETHICS APPROVAL
This research did not involve any clinical experimentation
or invasive procedures. As a social science-based survey
study, ethical concerns were minimal. The participants
were fully informed of the study's objectives, and verbal
consent was obtained before participation. No identifying
or sensitive personal information was collected.
FUNDING
This study received no specific funding from public,
commercial, or not-for-profit funding agencies.
AI TOOL DECLARATION
The authors declare that no AI or related tools are used to
write the scientific content of this manuscript.
DATA AVILABILITY
The data will be available upon request.
REFERENCES
Baharudin, N., Mohd Nasir, N. A., & Abdullah, M. F.
(2021). Association between perceived stress and
menstrual irregularities among university students.
International Journal of Environmental Research and
Public Health, 18(12), 6483.
Bozdag, G., Mumusoglu, S., & Yildiz, B. O. (2022). The
prevalence and phenotypic features of polycystic ovary
syndrome: A systematic review and meta-analysis.
Human Reproduction Update, 28(3), 375–394.
www.ijzab.com 165
Stress
Work-Life Balance
Importance
1 (low) – 5 (high) Scores 4–5: 27%, Scores 1–3: 73%
Stress-Reduction Activities Exercise, Meditation, Hobbies,
Socializing
Meditation: 41%, Hobbies: 32%, Exercise: 12%,
Socializing: 10%
Willingness to Use Free
Counselling
Yes, No, Maybe Yes: 34%, No: 42%, Maybe: 20%
Peer Support for Stress 1 (low) – 5 (high) 3–5: 50%, 1–2: 46%
Primary Source of Stress Open text Academic pressure
Experience of Low
Mood/Depression
Yes, No, Not sure Yes: 35%, No: 42%, Not sure: 20%
Thoughts of Self-Harm Yes, No, Maybe Yes: 30%, No: 47%, Maybe: 19%
Feeling Connected Very connected, Somewhat connected,
Somewhat isolated, Very isolated
Very/somewhat connected: 61%,
Somewhat/very isolated: 35%
Menstrual Hygiene
Awareness
Yes completely, Yes partially, No Fully aware: 40%, Partial/No: 60%
Notes: Percentages may not sum to 100% owing to rounding or multiple responses. Observations summarize patterns in
the data where applicable.
CONCLUSION
This study underscores the considerable and interconnected
health challenges faced by female university students, with
high levels of perceived stress, poor sleep quality, and
dysmenorrhea emerging as prominent concerns. These
findings reveal that stress and sleep deprivation not only
individually impair reproductive health but also interact
synergistically to exacerbate menstrual irregularities and
pain through disruptions in the hypothalamic–pituitary–
ovarian axis. Despite moderate awareness of the impact of
stress on hormonal health, health-seeking behaviors remain
limited, with many students refraining from consulting
medical professionals. At the same time, the majority
expressed openness to free counselling services,
highlighting a critical opportunity for institutions to
strengthen student support systems. By addressing
psychosocial stressors, promoting menstrual health literacy,
and fostering accessible, stigma-free healthcare pathways,
universities can help mitigate these burdens and enhance
the overall well-being and academic success of their
students.
ACKNOWLEDGEMENT
The research team sincerely acknowledges the support
provided by the Department of Zoology at Maharajah’s
Autonomous College, Vizianagaram. We are deeply
grateful to the students who participated in the survey.
Their candid responses and willingness to share personal
experiences made it possible to examine the lived realities
of young women managing menstrual irregularities. Special
thanks are also extended to the educational institutions in
Vizianagaram that facilitated data collection and
encouraged student-centered research initiatives. Their
collaboration reflects a strong commitment to fostering
undergraduate scholarships and inquiry.
CONFLICT OF INTERESTS
The authors declare no conflicts of interest.
ETHICS APPROVAL
This research did not involve any clinical experimentation
or invasive procedures. As a social science-based survey
study, ethical concerns were minimal. The participants
were fully informed of the study's objectives, and verbal
consent was obtained before participation. No identifying
or sensitive personal information was collected.
FUNDING
This study received no specific funding from public,
commercial, or not-for-profit funding agencies.
AI TOOL DECLARATION
The authors declare that no AI or related tools are used to
write the scientific content of this manuscript.
DATA AVILABILITY
The data will be available upon request.
REFERENCES
Baharudin, N., Mohd Nasir, N. A., & Abdullah, M. F.
(2021). Association between perceived stress and
menstrual irregularities among university students.
International Journal of Environmental Research and
Public Health, 18(12), 6483.
Bozdag, G., Mumusoglu, S., & Yildiz, B. O. (2022). The
prevalence and phenotypic features of polycystic ovary
syndrome: A systematic review and meta-analysis.
Human Reproduction Update, 28(3), 375–394.
Gopal Anapana et al. Int. J. Zool. Appl. Biosci., 10(5), 157-166, 2025
www.ijzab.com 166
Chan, C. M., Lo, W. S., & Ng, S. M. (2021). Mindfulness-
based stress reduction for female university students with
menstrual irregularities: A randomized controlled trial.
Complementary Therapies in Medicine, 56, 102603.
Eldeeb, R., Abdelrahman, A., & Hassan, S. (2022).
Lifestyle factors and menstrual health among female
university students. BMC Women’s Health, 22(1), 245.
Goyal, M., Singh, R., & Sharma, P. (2022). Barriers to
reproductive healthcare utilization among Indian college
women. Journal of Women’s Health, 31(9), 1274–1282.
Huang, J., Li, R., Liu, X., & Zhou, Y. (2021). Association
between perceived stress and menstrual irregularity
among Chinese college students: The mediating role of
sleep quality. BMC Women’s Health, 21(1), 311.
Kumar, S., Yadav, A., & Mishra, P. (2023). Stress, sleep
patterns, and menstrual health among female college
students: A cross-sectional study. Indian Journal of
Community Medicine, 48(1), 35–41.
Lee, H., Kim, M., & Park, S. (2023). Effects of lifestyle
modification on menstrual health and quality of life in
female university students: A randomized controlled trial.
International Journal of Environmental Research and
Public Health, 20(4), 3455.
Liu, Y., Chen, X., & Hu, H. (2023). Association between
sleep duration and menstrual pain severity in young
women. Sleep Health, 9(4), 407–414.
Maheshwari, A., Srivastava, S., & Kumari, R. (2021).
Menstrual health awareness and healthcare-seeking
behavior among college students in North India.
Reproductive Health, 18(1), 201.
Meczekalski, B., Katulski, K., Czyzyk, A., & Podfigurna,
A. (2020). Stress, HPA axis, and menstrual cycle
disturbances: An overview. Endocrine Regulations,
54(2), 90–99.
Musa, R., Lim, Y. M., & Ahmad, R. (2022). Sleep quality,
stress, and academic performance among university
students: Implications for health promotion. Sleep Health,
8(5), 490–497.
Shen, L., Zhang, H., Wu, Y., & Lin, X. (2022). Stress,
cortisol, and menstrual disorders in young women: A
population-based study. Journal of Psychosomatic
Research, 155, 110740.
Tsai, S. Y., Lee, P. L., & Lin, C. Y. (2022). The
effectiveness of campus health promotion programs on
menstrual health literacy. Journal of American College
Health, 70(8), 2325–2333.
Wu, H., Zhao, J., & Zhou, M. (2021). Combined effects of
stress and poor sleep on reproductive hormone function:
Evidence from young female workers. Frontiers in
Endocrinology, 12, 693517.
Zhang, Q., Zhao, H., & Chen, Y. (2024). Bidirectional
associations between sleep disturbance and menstrual
cycle disorders: A longitudinal analysis. Sleep Medicine,
110, 38–45.
Zhao, R., Chen, J., & Qiu, X. (2022). Sleep deprivation and
female reproductive health: A review of mechanisms and
clinical implications. Sleep Medicine Reviews, 65,
101659.
Zhou, W., Wang, X., & Yang, H. (2023). Stress-related
endocrine changes and their impact on reproductive
function in women with PCOS. Frontiers in
Endocrinology, 14, 1176542.
www.ijzab.com 166
Chan, C. M., Lo, W. S., & Ng, S. M. (2021). Mindfulness-
based stress reduction for female university students with
menstrual irregularities: A randomized controlled trial.
Complementary Therapies in Medicine, 56, 102603.
Eldeeb, R., Abdelrahman, A., & Hassan, S. (2022).
Lifestyle factors and menstrual health among female
university students. BMC Women’s Health, 22(1), 245.
Goyal, M., Singh, R., & Sharma, P. (2022). Barriers to
reproductive healthcare utilization among Indian college
women. Journal of Women’s Health, 31(9), 1274–1282.
Huang, J., Li, R., Liu, X., & Zhou, Y. (2021). Association
between perceived stress and menstrual irregularity
among Chinese college students: The mediating role of
sleep quality. BMC Women’s Health, 21(1), 311.
Kumar, S., Yadav, A., & Mishra, P. (2023). Stress, sleep
patterns, and menstrual health among female college
students: A cross-sectional study. Indian Journal of
Community Medicine, 48(1), 35–41.
Lee, H., Kim, M., & Park, S. (2023). Effects of lifestyle
modification on menstrual health and quality of life in
female university students: A randomized controlled trial.
International Journal of Environmental Research and
Public Health, 20(4), 3455.
Liu, Y., Chen, X., & Hu, H. (2023). Association between
sleep duration and menstrual pain severity in young
women. Sleep Health, 9(4), 407–414.
Maheshwari, A., Srivastava, S., & Kumari, R. (2021).
Menstrual health awareness and healthcare-seeking
behavior among college students in North India.
Reproductive Health, 18(1), 201.
Meczekalski, B., Katulski, K., Czyzyk, A., & Podfigurna,
A. (2020). Stress, HPA axis, and menstrual cycle
disturbances: An overview. Endocrine Regulations,
54(2), 90–99.
Musa, R., Lim, Y. M., & Ahmad, R. (2022). Sleep quality,
stress, and academic performance among university
students: Implications for health promotion. Sleep Health,
8(5), 490–497.
Shen, L., Zhang, H., Wu, Y., & Lin, X. (2022). Stress,
cortisol, and menstrual disorders in young women: A
population-based study. Journal of Psychosomatic
Research, 155, 110740.
Tsai, S. Y., Lee, P. L., & Lin, C. Y. (2022). The
effectiveness of campus health promotion programs on
menstrual health literacy. Journal of American College
Health, 70(8), 2325–2333.
Wu, H., Zhao, J., & Zhou, M. (2021). Combined effects of
stress and poor sleep on reproductive hormone function:
Evidence from young female workers. Frontiers in
Endocrinology, 12, 693517.
Zhang, Q., Zhao, H., & Chen, Y. (2024). Bidirectional
associations between sleep disturbance and menstrual
cycle disorders: A longitudinal analysis. Sleep Medicine,
110, 38–45.
Zhao, R., Chen, J., & Qiu, X. (2022). Sleep deprivation and
female reproductive health: A review of mechanisms and
clinical implications. Sleep Medicine Reviews, 65,
101659.
Zhou, W., Wang, X., & Yang, H. (2023). Stress-related
endocrine changes and their impact on reproductive
function in women with PCOS. Frontiers in
Endocrinology, 14, 1176542.