My sister experienced her first period at the young age of seven and a half. Unprepared for the associated pain, she was overwhelmed both mentally and physically. Mysteriously, her periods stopped for nearly four years before resuming at age 12.


Menarche, the first menstrual period, typically occurs between ages 10 and 16, with an average onset of 12.4 years. It often arrives unexpectedly and is usually painless. However, recent research by the National Institute of Health (NIH) indicates that menstruation is either delayed or begins earlier than usual in countries heavily impacted by climate change.

Pakistan is among the countries most affected by this global crisis. Over the past 50 years, its annual mean temperature has risen by about 0.5°C, with the frequency of heatwaves increasing nearly five-fold. In May 2022, during record-breaking temperatures, 16-year-old Fariha Atiq, who started menstruating at age nine, experienced the most painful period of her life.
“I was completely unprepared to deal with my period. Although I managed initially, seasonal changes worsened my cramps. From April to August in 2022, I couldn't move my legs during my menstrual cycle,” Fariha shared.


Despite consulting various gynecologists, who deemed her severe pain 'normal,' Fariha’s mother continued searching for answers. Eventually, they consulted Dr. Junaid Ansari, an obstetrics expert at Abbasi Shaheed Hospital in Karachi. He attributed Fariha's pain to elevated cortisol levels, a stress hormone influenced by temperature.

Cortisol levels rise with increasing temperatures, contributing to dysmenorrhea, which nearly immobilized Fariha. Cortisol, released during stressful situations, regulates blood sugar levels, metabolism, and blood pressure, and acts as an anti-inflammatory agent. It also influences the menstrual cycle and prepares the body for pregnancy. Dr. Ansari noted that seasonal changes affect cortisol release, disrupting menstrual cycles.

Recent observations and research have shown that extreme heat peaks cortisol levels. Dr. Ansari recounted a case of a 12-year-old girl with severe cramps during the summer of 2022, whose cortisol levels were significantly above normal. Monitoring revealed that her levels returned to normal after rainfall.
The link between hormones and rising temperatures is clear: extreme stress disrupts hormonal glands, impacting estrogen levels necessary for female reproductive health. Researchers at Poznan University of Medical Sciences in Poland identified seasonal cortisol patterns in female medical students, with higher levels in summer

Dysmenorrhea, or severe menstrual pain, is often misdiagnosed as normal. Dr. Asifa Sofia from Abbasi Shaheed Hospital noted that severe cramps have become more common in the past five years, often worsening in winter due to hormonal changes influenced by erratic weather patterns. This affects follicle sizes, altering estrogen levels and menstrual cycles.

Sabiha, a patient from Thar, experienced severe abdominal pain and irregular periods following extreme heat. Her condition highlights how fluctuating temperatures impact follicle sizes and estrogen levels, disrupting menstrual cycles.


Climate change-induced natural disasters also contribute to menstrual irregularities. Geetanjali, from Balochistan’s Nasirabad district, experienced random bleeding and severe cramps after floods displaced her. Exposure to pollutants and stress from displacement further disrupted her menstrual cycle.


Erratic weather patterns affect menstruation in both summer and winter. Women report intensified cramps during cold months due to hormonal imbalances and restricted blood flow. Dr. Tahira Masood from Liaquat National Hospital explained that cold weather increases prostaglandins, hormone-like substances causing painful cramps.


While discussions about menstruation have become more common, awareness about the impact of climate change on menstrual health is still limited. Addressing gender equity and underlying barriers is crucial for tackling the climate crisis and improving women’s health.

As Pakistan grapples with climate change, it is essential to understand and address its impact on menstrual health. Sustainable solutions, such as temperature-dependent tampons and hormonal medicines, need to be normalized to support women's health in the long run.