Effects of climate change on menstrual health and hygiene: a global mixed-methods systematic review

Menstrual health and hygiene (MHH) encompasses access to menstrual materials; water, sanitation, and disposal facilities; privacy and safety; accurate information; supportive social environments; access to care for menstrual discomfort and disorders; enabling people to manage menstruation with dignity and choice. Climate change is disrupting these interlinked domains, disproportionately affecting women, girls, and people who menstruate. This review synthesises evidence on how climate change affects MHH across diverse climate hazard contexts. We conducted a global mixed-methods systematic review of studies published in English between 1947 and 2025, examining associations between climate-related hazards and MHH. We conducted searches in Medline, Scopus, Embase, and Web of Science. Quantitative, qualitative, and mixed-methods studies were eligible. Given the heterogeneity in exposures, outcomes, and designs, findings were synthesised narratively. From 3,890 records, 25 studies met inclusion criteria, covering floods (n=7), air pollution (n=6), cyclones (n=3), droughts (n=3), saltwater intrusion (n=2), and multiple hazards (n=4). Flood- and cyclone-related studies reported disrupted access to menstrual materials, damaged water and sanitation infrastructure, reduced privacy and safety, limited access to care for menstrual disorders, and unsupportive social environments characterised by stigma and restricted mobility. Drought and salinity intrusion constrained hygiene practices through reduced water availability and quality, affecting comfort, dignity, and infection risk. Across hazards, studies documented adverse physical outcomes, including dermatological irritation and reproductive or urinary tract infections, alongside psychosocial consequences such as shame, anxiety, and harassment. Air pollution studies linked exposures with earlier menarche and menstrual cycle irregularities. Evidence on extreme heat and several MHH domains, including access to information, was limited. Climate-related hazards undermine multiple, interconnected domains of MHH. The evidence base remains fragmented across hazards, geographies, methods, underscoring the need to integrate MHH into climate adaptation, disaster preparedness, and humanitarian response frameworks and to address critical research gaps related to extreme heat, slow-onset hazards, and equity.