Table 3. Summary table of studies contributing to each theme according to trustworthiness.
| Theme | High trustworthiness (n = 36 studies) | Medium trustworthiness (n = 48 studies) | Low trustworthiness (n = 20 studies) |
|---|---|---|---|
| ANTECEDENTS | |||
| Socio-cultural context (n = 71 studies) | n = 29 studies [26, 28, 33, 39, 40, 47, 51, 53, 58, 59, 61, 65, 67, 68, 73, 86, 93–97, 105, 111, 112, 114, 119–122, 132, 135, 137, 139] | n = 31 studies [24, 32, 36, 38, 42, 43, 48, 54–57, 60, 63, 69–72, 78–81, 84, 85, 87–90, 98, 103, 106, 108–110, 116, 117, 127, 128] | n = 11 studies [8, 9, 46, 49, 64, 92, 101, 129, 130, 136, 140] |
| Menstrual stigma, n = 24 studies [28, 33, 40, 47, 53, 58, 59, 61, 67, 68, 73, 86, 93–97, 105, 111, 112, 114, 119–121, 132, 135, 137, 139] | Menstrual stigma, n = 28 studies [24, 32, 38, 42, 48, 54–56, 60, 63, 69–72, 78–81, 84, 85, 87–90, 98, 108–110, 116, 117, 127, 128] | Menstrual stigma, n = 9 studies [8, 9, 49, 64, 92, 101, 129, 130, 136] | |
| Gender norms, n = 23 studies [26, 28, 33, 39, 40, 47, 51, 58, 59, 61, 65, 67, 73, 93–97, 105, 111, 114, 119–122, 132, 135] | Gender norms, n = 26 studies [24, 32, 36, 38, 43, 54–57, 60, 63, 69, 71, 78, 80, 81, 85, 87, 88, 98, 103, 106, 108–110, 116, 117, 127, 128] | Gender norms, n = 7 studies [46, 49, 64, 92, 101, 129, 140] | |
| Behavioural expectations (n = 69 studies) | n = 24 studies [28, 33, 40, 47, 51, 53, 58, 59, 65, 67, 68, 73–77, 86, 93–97, 105, 111, 112, 119–122, 139] | n = 26 studies [32, 36, 38, 42, 45, 48, 54–56, 60, 63, 66, 71, 78, 79, 81, 84, 87–89, 106–110, 116–118, 125, 128, 133, 143] | n = 9 studies [8, 35, 41, 49, 50, 64, 92, 129, 136] |
| Externally enforced, n = 15 studies [33, 51, 58, 65, 67, 73, 86, 93–97, 105, 112, 119–121] | Externally enforced, n = 22 studies [32, 36, 38, 42, 45, 54, 56, 60, 63, 66, 71, 78, 80, 81, 84, 89, 106, 108–110, 116, 117, 125, 128, 143] | Externally enforced, n = 6 studies [8, 35, 49, 64, 92, 136] | |
| Internally enforced, n = 24 studies [28, 33, 40, 47, 51, 53, 58, 59, 65, 67, 68, 73–77, 86, 93, 95–97, 105, 111, 112, 119–122, 139] | Internally enforced, n = 22 studies [32, 38, 48, 54–56, 60, 65–67, 71, 78–81, 84, 87–89, 93, 94, 106–110, 116–118, 125, 128, 133, 143] | Internally enforced, n = 6 studies [8, 41, 49, 50, 64, 129] | |
| Social support (n = 83 studies) | n = 27 studies [26, 28, 33, 34, 40, 47, 51, 58, 59, 61, 65, 67, 73, 75–77, 93–97, 99, 105, 111, 112, 114, 119–122, 124, 135, 137] | n = 39 studies [24, 25, 27, 32, 36–38, 42, 43, 48, 54–57, 60, 63, 66, 69–72, 78–81, 84, 85, 87–90, 100, 102, 103, 106, 108–110, 115–118, 125, 127, 128, 138, 143] | n = 17 studies [8–10, 35, 46, 49, 50, 62, 64, 82, 83, 101, 104, 113, 129, 136, 140, 141] |
| Adolescent boys, n = 7 studies [42, 75, 93, 95–97, 99, 114, 121] | Adolescent boys, n = 10 studies [32, 54, 78, 81, 88–90, 110, 117, 127, 143] | Adolescent boys, n = 2 studies [35, 141] | |
| Healthcare workers, n = 16 studies [26, 28, 40, 51, 58, 59, 61, 67, 75, 77, 99, 111, 112, 119, 120, 122, 137] | Healthcare workers, n = 13 studies [27, 55–57, 63, 71, 80, 81, 85, 100, 103, 106, 128] | Healthcare workers, n = 5 studies [8, 46, 64, 101, 129] | |
| Family (not including mothers), n = 11 studies [51, 61, 65, 67, 95, 99, 111, 119, 121, 122, 135] | Family (not including mothers), n = 17 studies [25, 32, 38, 43, 54, 56, 57, 60, 63, 71, 87, 89, 90, 103, 106, 109, 110, 127] | Family (not including mothers), n = 6 studies [35, 62, 113, 136, 140, 144] | |
| Friends and colleagues, n = 19 studies [28, 40, 47, 51, 61, 65, 67, 75, 76, 94, 95, 97, 99, 105, 112, 114, 119, 121, 122, 124, 135] | Friends and colleagues, n = 23 studies [24, 25, 32, 37, 38, 43, 48, 56, 63, 71, 78, 79, 81, 87, 88, 103, 106, 110, 115, 118, 127, 128, 138] | Friends and colleagues, n = 7 studies [8–10, 35, 64, 129, 136, 140] | |
| Intimate partners, n = 10 studies [33, 34, 51, 61, 73, 75, 112, 114, 119, 122, 137] | Intimate partners, n = 8 studies [56, 66, 81, 103, 106, 116, 125, 128, 143] | Intimate partners, n = 1 study [64] | |
| Mothers, n = 14 studies [34, 47, 61, 65, 76, 93–96, 99, 114, 119–122, 135] | Mothers, n = 25 studies [25, 32, 36, 38, 42, 43, 54, 56, 57, 63, 69–72, 79, 81, 84, 88, 102, 106–110, 116, 125, 127, 128] | Mothers, n = 13 studies [8, 35, 49, 50, 62, 64, 82, 83, 104, 113, 129, 140, 141] | |
| Knowledge (n = 57 studies) | n = 20 studies [33, 39, 47, 51, 58, 59, 67, 74, 75, 86, 91, 93–97, 99, 105, 114, 119–122, 135] | n = 27 studies [32, 36, 38, 42, 43, 45, 55–57, 60, 63, 69–72, 78, 81, 85, 87–89, 102, 106, 109, 110, 116, 117, 127, 128] | n = 10 studies [8, 35, 41, 50, 64, 104, 130, 136, 140, 141] |
| Biology, n = 16 studies [39, 58, 59, 65, 67, 74, 75, 91, 93–97, 105, 114, 119–122, 135] | Biology, n = 24 studies [32, 36, 38, 42, 45, 55–57, 60, 63, 69–72, 81, 85, 87, 89, 102, 106, 109, 110, 116, 127, 128] | Biology, n = 10 studies [8, 35, 41, 50, 64, 104, 130, 136, 141] | |
| Reproduction, n = 5 studies [33, 58, 74, 95, 120] | Reproduction, n = 8 studies [32, 56, 60, 63, 71, 78, 81, 106] | Reproduction, n = 1 study [41] | |
| Physical management, n = 16 studies [39, 47, 51, 58, 86, 91, 94–96, 99, 105, 114, 119–122, 135] | Physical management, n = 17 studies [32, 36, 38, 42, 43, 56, 63, 69, 71, 72, 81, 88, 106, 110, 116, 117, 127] | Physical management, n = 4 studies [8, 50, 104, 140] | |
| Resource limitations (n = 31 studies) | n = 13 studies [26, 28, 40, 47, 51, 94, 111, 119, 120, 122, 126, 132] | n = 16 studies [24, 25, 37, 48, 54, 56, 78, 80, 81, 88, 98, 106, 108, 115, 117, 138, 143] | n = 2 studies [8–10] |
| Economic environment, n = 5 studies [40, 114, 119, 120, 126] | Economic environment, n = 8 studies [37, 48, 56, 81, 98, 106, 117, 143] | Economic environment, n = 2 studies [8–10] | |
| Physical environment, n = 10 studies [26, 28, 47, 51, 94, 111, 120, 122, 126, 132] | Physical environment, n = 10 studies [25, 54, 78, 80, 81, 88, 106, 108, 115, 117, 138] | Physical environment, n = 1 study [10] | |
| EXPERIENCES | |||
| Menstrual practices (n = 71 studies) | n = 24 studies [28, 33, 47, 51, 59, 67, 68, 75, 76, 86, 91, 93–96, 99, 105, 112, 114, 119–123, 126, 132, 135, 137] | n = 34 studies [24, 25, 32, 36–38, 42, 44, 48, 54, 56, 57, 60, 63, 66, 69, 71, 72, 78–81, 84, 88, 89, 102, 106, 108–110, 115–118, 128, 138, 142, 143] | n = 13 studies [8–10, 41, 46, 50, 64, 82, 83, 92, 104, 113, 136, 140] |
| Bathing, n = 7 studies [47, 68, 86, 95, 105, 120, 132] | Bathing, n = 7 studies [32, 38, 56, 60, 66, 138, 143] | Bathing, n = 2 studies [10, 140] | |
| Disposing of materials, n = 9 studies [28, 47, 59, 95, 105, 112, 120, 122, 132, 135] | Disposing of materials, n = 10 studies [24, 32, 38, 42, 80, 81, 88, 102, 110, 116, 117, 138] | Disposing of materials, n = 2 studies [41, 50] | |
| Obtaining materials, n = 14 studies [47, 59, 67, 75, 76, 93–96, 99, 119–121, 126, 132, 135] | Obtaining materials, n = 18 studies [24, 37, 38, 48, 54, 56, 63, 69, 71, 78, 79, 81, 89, 106, 109, 110, 115–117, 138, 143] | Obtaining materials, n = 7 studies [8–10, 50, 64, 82, 83, 113] | |
| Using/wearing materials, n = 14 studies [28, 33, 47, 51, 59, 67, 68, 86, 91, 93–96, 105, 112, 114, 119, 120, 122, 123, 126, 135, 137] | Using/wearing materials, n = 26 studies [24, 25, 32, 36–38, 42, 44, 54, 56, 57, 60, 63, 69, 71, 72, 78–81, 84, 88, 89, 102, 106, 108–110, 115–118, 128, 138, 142] | Using/wearing materials, n = 9 studies [8–10, 41, 46, 49, 50, 64, 82, 83, 92, 104, 113, 136, 140] | |
| Washing/drying materials, n = 6 studies [28, 93–95, 105, 114, 132] | Washing/drying materials, n = 4 studies [37, 56, 81, 106, 108, 116, 117] | Washing/drying materials, n = 2 studies [10, 50] | |
| Perceptions of menstrual practices (n = 55 studies) | n = 20 studies [28, 47, 51, 59, 67, 68, 86, 93–97, 99, 105, 112, 114, 119–123, 126, 132, 137] | n = 24 studies [24, 32, 36–38, 42, 54, 56, 57, 60, 63, 69, 71, 72, 78–81, 84, 88, 106, 108–110, 116, 117, 128, 138] | n = 11 studies [8–10, 41, 46, 49, 50, 64, 82, 92, 113, 136] |
| Bathing, n = 2 studies [47, 105] | Bathing, n = 2 studies [56, 143] | Bathing, n = 0 studies | |
| Disposing of materials, n = 11 studies [28, 47, 51, 59, 105, 112, 114, 120–122, 132] | Disposing of materials, n = 7 studies [24, 25, 38, 42, 81, 88, 116, 117] | Disposing of materials, n = 2 studies [41, 50] | |
| Obtaining materials, n = 7 studies [67, 94, 96, 119–121, 132] | Obtaining materials, n = 8 studies [24, 37, 54, 56, 63, 78, 79, 81, 116] | Obtaining materials, n = 4 studies [8–10, 64, 82] | |
| Using/wearing materials (all), n = 18 studies [28, 47, 51, 59, 68, 86, 93–96, 99, 105, 112, 114, 119–123, 126, 137] | Using/wearing materials (all), n = 27 studies [24, 25, 27, 32, 36–38, 44, 54, 56, 57, 60, 63, 69, 71, 72, 78–81, 84, 88, 106, 108–110, 116, 117, 127, 128, 138] | Using/wearing materials (all), n = 11 studies [8–10, 41, 46, 49, 50, 64, 82, 92, 113, 136] | |
| Using/wearing tampons, n = 6 studies [51, 68, 95, 99, 105, 121] | Using/wearing tampons, n = 15 studies [27, 32, 36, 37, 44, 56, 63, 69, 79–81, 106, 110, 116, 117, 127] | Using/wearing tampons, n = 6 studies [41, 49, 50, 64, 82, 113] | |
| Washing/drying materials, n = 2 studies [93, 94, 114] | Washing/drying materials, n = 5 studies [37, 56, 81, 106, 108, 116, 117] | Washing/drying materials, n = 1 study [50] | |
| Perceptions of physical environment (n = 18 studies) | n = 8 studies [26, 28, 47, 51, 111, 122, 126, 132] | n = 9 studies [24, 25, 54, 80, 81, 88, 115, 117, 138] | n = 1 study [10] |
| Negative emotional responses (n = 87 studies) | n = 33 studies [28, 33, 34, 40, 47, 51, 53, 58, 59, 61, 65, 67, 68, 73–77, 86, 91, 93–97, 99, 105, 111, 112, 114, 119–122, 124, 126, 132, 135, 137, 139] | n = 37 studies [24, 25, 27, 32, 36–38, 42, 44, 45, 48, 54–57, 60, 69–72, 78–81, 85, 87–90, 98, 100, 106, 108–110, 116–118, 125, 127, 128, 138, 143] | n = 17 studies [8–10, 35, 46, 49, 50, 62, 64, 82, 92, 101, 104, 113, 129, 136, 140, 141] |
| Bother, n = 16 studies [47, 53, 58, 59, 65, 68, 75, 77, 94, 95, 105, 112, 119, 120, 122, 124, 135] | Bother, n = 18 studies [25, 36, 38, 54, 56, 69, 71, 72, 78, 80, 81, 87, 98, 106, 108–110, 117, 128, 138] | Bother, n = 7 studies [8, 35, 46, 49, 64, 140, 141] | |
| Disgust, n = 16 studies [28, 33, 47, 58, 68, 73, 74, 86, 93, 94, 96, 97, 99, 111, 114, 119–121, 132, 135] | Disgust, n = 15 studies [32, 38, 54–56, 60, 70, 79, 81, 87, 98, 110, 117, 138, 143] | Disgust, n = 3 studies [64, 92, 136] | |
| Shame and distress, n = 28 studies [28, 33, 34, 40, 47, 51, 53, 58, 59, 61, 67, 68, 75, 76, 86, 93–97, 99, 105, 111, 112, 114, 119–121, 132, 135, 137, 139] | Shame and distress, n = 27 studies [24, 27, 32, 38, 44, 48, 54–56, 69, 71, 72, 78–81, 85, 87–90, 98, 100, 106, 108–110, 116, 117, 125, 127, 128, 143] | Shame and distress, n = 13 studies [8, 9, 46, 50, 64, 82, 101, 104, 113, 129, 136, 140, 141] | |
| Positive emotional responses (n = 42 studies) | n = 14 studies [26, 33, 40, 47, 68, 73–75, 93–97, 105, 114, 119, 120, 135] | n = 19 studies [27, 32, 37, 43, 54, 56, 60, 63, 69–71, 78, 80, 81, 85, 88, 98, 106, 143] | n = 9 studies [46, 49, 62, 64, 83, 104, 129, 136, 141] |
| Pride, n = 0 studies | Pride, n = 4 studies [32, 78, 106, 143] | Pride, n = 1 study [136] | |
| Relief, n = 11 studies [26, 40, 47, 68, 75, 93, 94, 96, 105, 114, 119, 120, 135] | Relief, n = 12 studies [27, 32, 43, 56, 60, 69–71, 80, 85, 98, 106] | Relief, n = 7 studies [46, 49, 62, 64, 104, 129, 141] | |
| Confidence to engage in other activities during menstruation (n = 16 studies) | n = 9 studies [28, 33, 40, 47, 73, 112, 114, 119, 122] | n = 7 studies [38, 56, 80, 81, 106, 108, 117, 118] | n = 0 studies |
| Individual menstrual factors (n = 71 studies) | n = 29 studies [26, 28, 33, 34, 39, 40, 47, 51–53, 58, 59, 61, 65, 67, 73, 75–77, 93, 95, 96, 99, 105, 112–114, 119–122, 124, 135, 137] | n = 32 studies [24, 25, 27, 32, 36–38, 54–56, 60, 63, 69, 71, 72, 78, 80, 81, 85, 87, 100, 102, 103, 106, 107, 109, 110, 116, 127, 128, 133, 134, 138, 142] | n = 10 studies [8–10, 35, 41, 46, 49, 62, 64, 129, 140] |
| Fatigue, n = 13 studies [33, 34, 40, 51, 61, 76, 77, 111, 114, 119, 120, 122, 137] | Fatigue, n = 8 studies [25, 56, 72, 79, 80, 87, 100, 138] | Fatigue, n = 3 studies [9, 41, 140] | |
| Gastrological, n = 10 studies [40, 51, 53, 58, 61, 75, 76, 114, 128, 135] | Gastrological, n = 7 studies [55, 56, 71, 80, 106, 128, 134] | Gastrological, n = 3 studies [8, 49, 140] | |
| Neurological, n = 10 studies [51, 53, 61, 75, 76, 114, 119, 120, 122, 128] | Neurological, n = 9 studies [32, 55, 56, 71, 72, 78, 80, 106, 128] | Neurological, n = 2 studies [8, 41] | |
| Pain, n = 29 studies [26, 28, 33, 34, 39, 40, 47, 51–53, 58, 59, 61, 65, 67, 73, 75–77, 93, 95, 96, 99, 105, 112, 114, 119–122, 124, 135, 137] | Pain, n = 31 studies [24, 25, 27, 32, 36–38, 54–56, 60, 63, 69, 71, 72, 78–81, 85, 87, 102, 103, 106, 107, 109, 110, 116, 127, 128, 133, 134, 138, 142] | Pain, n = 9 studies [8–10, 35, 41, 46, 49, 62, 64, 129] | |
| Pain management (n = 47 studies) | n = 24 studies [26, 28, 33, 34, 40, 47, 51–53, 58, 59, 61, 65, 67, 73, 75, 77, 93, 105, 112, 114, 119, 120, 122, 137] | n = 18 studies [32, 38, 44, 55, 56, 63, 71, 79–81, 102, 106, 116, 127, 128, 133, 138, 142] | n = 5 studies [8–10, 41, 64, 129] |
| Perceptions of pain management, n = 15 studies [33, 34, 40, 47, 51, 53, 58, 61, 67, 73, 77, 105, 119, 120, 122] | Perceptions of pain management, n = 12 studies [32, 44, 55, 56, 71, 80, 81, 102, 106, 116, 128, 133] | Perceptions of pain management, n = 3 studies [8, 64, 129] | |
| Use of: | Use of: | Use of: | |
| Alcohol, n = 1 study [93] | Alcohol, n = 2 studies [32, 106] | Alcohol, n = 0 studies | |
| Heat, n = 9 studies [34, 40, 52, 53, 58, 59, 61, 120, 122] | Heat, n = 4 studies [34, 56, 71, 80, 142] | Heat, n = 0 studies | |
| Herbal remedies, n = 5 studies [40, 65, 67, 105, 122] | Herbal remedies, n = 1 study [55] | Herbal remedies, n = 1 study [41] | |
| Hormonal contraceptives, n = 2 studies [51, 58, 61, 77, 105, 120] | Hormonal contraceptives, n = 5 studies [56, 80, 81, 116, 133] | Hormonal contraceptives, n = 4 studies [8, 10, 64, 129] | |
| Analgesic or anti-inflammatory medicines, n = 17 studies [26, 34, 40, 47, 51–53, 58, 61, 67, 75, 77, 112, 114, 120, 122, 137] | Analgesic or anti-inflammatory medicines, n = 15 studies [32, 38, 56, 63, 71, 79–81, 102, 106, 127, 128, 133, 138, 142] | Analgesic or anti-inflammatory medicines, n = 2 studies [64, 129] | |
| Sex, n = 2 studies [33, 73] | Sex, n = 1 study [56] | Sex, n = 1 study [41] | |
| IMPACTS | |||
| Mental burden (n = 36 studies) | n = 14 studies [40, 47, 51, 53, 61, 77, 95, 112, 119, 120, 122, 126, 132, 137] | n = 22 studies [25, 36, 38, 55, 56, 69–71, 78–81, 88, 98, 103, 106, 109, 117, 118, 128, 134, 138, 143] | n = 4 studies [46, 49, 64, 129] |
| Participation (n = 72 studies) | n = 25 studies [28, 34, 40, 47, 51–53, 58, 61, 65, 67, 76, 77, 86, 93–96, 99, 105, 111, 112, 114, 119, 120, 122, 135, 137] | n = 35 studies [25, 27, 32, 36–38, 44, 45, 48, 54–57, 60, 63, 71, 72, 79–81, 84, 87, 98, 100, 103, 106–110, 116–118, 127, 128, 134, 138, 143] | n = 12 studies [8, 41, 49, 50, 64, 92, 101, 113, 129–131, 136, 141] |
| Participate but would prefer not to, n = 9 studies [40, 47, 53, 58, 61, 77, 105, 112, 122] | Participate but would prefer not to, n = 9 studies [56, 63, 80, 98, 100, 106, 107, 109, 128, 138] | Participate but would prefer not to, n = 2 studies [8, 64] | |
| Employment is impacted, n = 10 studies [34, 47, 53, 61, 76, 105, 111, 112, 114, 119, 122] | Employment is impacted, n = 7 studies [34, 56, 57, 80, 100, 103, 106, 108, 118] | Employment is impacted, n = 2 studies [64, 129] | |
| Participation in physical activities is impacted, n = 10 studies [34, 40, 47, 51, 65, 77, 93–95, 99, 105, 112] | Participation in physical activities is impacted, n = 19 studies [27, 32, 36, 38, 44, 45, 54, 56, 60, 63, 71, 72, 80, 81, 87, 106, 108, 109, 116, 127] | Participation in physical activities is impacted, n = 6 studies [8, 41, 49, 50, 113, 141] | |
| Do not participate in ‘cold’ activities, n = 3 studies [65, 94, 95, 105] | Do not participate in ‘cold’ activities, n = 7 studies [45, 56, 63, 71, 81, 84, 106, 108] | Do not participate in ‘cold’ activities, n = 2 studies [41, 50] | |
| Do not participate in religious practices, n = 3 studies [67, 86, 120] | Do not participate in religious practices, n = 2 studies [60, 63] | Do not participate in religious practices, n = 2 studies [8, 92] | |
| Do not participate in education, n = 6 studies [34, 47, 58, 61, 65, 122] | Do not participate in education, n = 12 studies [32, 36, 48, 56, 63, 71, 80, 87, 103, 107, 127, 143] | Do not participate in education, n = 5 studies [8, 49, 64, 101, 129] | |
| Do not participate in social activities, n = 11 studies [34, 40, 58, 61, 65, 93–95, 99, 112, 119, 122, 135] | Do not participate in social activities, n = 10 studies [36, 38, 45, 48, 71, 72, 80, 81, 87, 106] | Do not participate in social activities, n = 3 studies [41, 92, 129] | |
| Relationships (n = 37 studies) | n = 15 studies [33, 34, 40, 47, 61, 67, 73, 74, 86, 93, 105, 112, 119, 122, 132, 137] | n = 16 studies [24, 25, 32, 38, 55, 56, 60, 69, 71, 78, 80, 81, 88, 100, 106, 116] | n = 6 studies [49, 64, 101, 104, 129, 140] |
| Intimate partner, n = 12 studies [33, 47, 61, 67, 73, 74, 86, 93, 105, 112, 119, 122, 137] | Intimate partner, n = 7 studies [38, 56, 60, 80, 81, 100, 116] | Intimate partner, n = 2 studies [101, 104] | |
| Friends/family/colleagues, n = 7 studies [34, 40, 47, 61, 93, 119, 132] | Friends/family/colleagues, n = 10 studies [24, 25, 32, 55, 56, 69, 71, 78, 88, 106] | Friends/family/colleagues, n = 4 studies [49, 64, 129, 140] | |
Italicised terms provide citations for sub-themes within the overarching themes in the first column.