A cross-sectional study on menstrual health difficulties and premenstrual symptomatology in adolescent girls with intellectual disability: a salutogenic public health perspective.

Background: Adolescent girls with Intellectual disability (ID) are amongst the most vulnerable and underserved populations with special menstrual health needs. The prevalence of menstrual difficulties and premenstrual symptoms among people with ID often goes unrecognized, is poorly communicated and poorly managed which in turn contributes to functional limitations, increased caregiver burden and reduced quality of life. There is a lack of evidence from India regarding multidimensional PMS patterns and integrated supportive care approaches for girls with ID. Objective: To assess menstrual health difficulties and premenstrual symptom patterns among adolescent girls with intellectual disability and to describe multidisciplinary supportive care recommendations within a salutogenic public health framework. Methods: A cross-sectional school-based survey was conducted among 52 adolescent girls with mild to moderate ID aged 10-19 years in selected special schools of Puducherry. Menstrual history and hygiene practices were assessed by a gynecologist, and premenstrual symptoms across psychological, physical, and behavioral domains were evaluated using a caregiver-reported PMS screening tool over three consecutive cycles. Symptom clustering was performed by multidisciplinary experts. Exploratory inferential analysis was conducted using appropriate statistical tests to examine associations between level of intellectual disability and key menstrual health variables. Results: Dysmenorrhea was reported by 94.2% of participants with severe pain of 67.3%. Nearly half of them experienced menstrual irregularities, and over 90% needed partial to complete caregiver assistance in menstrual hygiene. Premenstrual symptoms were common across the domains: mood variability, irritability, pain, aggression, hypersomnia, and school absenteeism. Exploratory analysis showed no significant differences in symptom domain scores across levels of intellectual disability; however, hygiene dependence was significantly higher among adolescents with moderate intellectual disability. All participants exhibited overlapping symptom clusters-warranting integrated multidisciplinary recommendations. Routine supportive care gynecological, psychiatric, and yoga-based strategies were given. Emphasis was also laid on non-pharmacological management, behavior regulation, and body-mind coping. Conclusion: Adolescent girls with ID face a high burden of menstrual and premenstrual difficulties across physical, psychological, and behavioral domains. A salutogenic, multidisciplinary approach to gynecological care, together with behavioral support and yoga-based interventions, provided a culturally feasible framework for addressing menstrual health needs within special-school settings. For longitudinal effectiveness, such integrated strategies need to be evaluated.