Menstrual Health Instrument (MHI)

Menstrual Health Instrument (MHI) is a 29-item scale to holistically measure the physical and emotional menstrual health of adolescents. Items cover five sub-scales, including affective symptoms, somatic symptoms and school life, daily habits for menstrual health, menstrual cycle characteristics and attitudes and perceptions on menstruation.


Geographies Tested: Korea, South

Populations Included: Female

Age Range: Adolescents


Affective Symptoms
1. I feel everything bothersome and want to be alone before my period.
2. I feel anxious or depressed before my period.
3. I feel irritable or annoyed before my period.
4. I become sensitive before my period.
5. I sleep too much or have trouble falling asleep before my period.
6. I feel tired or weak before my period.
7. I have mood swings during my period.
8. Before my period, I am not in control of my emotions and feel overwhelmed.
9. I have poor concentration before my period.
10. I have changes in appetite before my period.
11. I have difficulty concentrating during my period.
12. I have headaches during my period.

Somatic symptoms
13. Menstrual symptoms interfere with my classroom activities.
14. I have severe cramping during my period.
15. I have difficulty in out-of-classroom activities due to my menstrual symptoms.
16. I have low abdominal pain or discomfort during my period.
17. Sometimes, due to menstrual symptoms, I am tardy or absent from school, or come home before school is out.
18. My body conditions during menstruation are not very different from usual conditions.
19. Menstrual cramping is more painful under stressful situations such as tests or exams.
20. I have backache during my period.
21. I have physical symptoms before my period (e.g. swelling of hands or foot, painful breasts, and bloating)

Daily habits for menstrual health
22. I have dietary habits of eating less salty food and taking less caffeine.
23. I enjoy wearing clothes which are air permeable instead of tight pants.
24. I usually keep my body warm.

Menstrual cycle characteristics
25. My menstrual cycle is regular.
26. The length of my menstrual cycle is between 21 and 45 days.
27. I have healthy menstrual cycles and periods.

Attitudes and perceptions on menstruation
28. Menstruation is a natural phenomenon, which is integral to body functions in women.
29. In think menstruation is an important indicator of women's overall health.

Response Options:
4-point Likert scale
Not at all - 1
Extremely - 4

Scoring Procedures

Certain items are reverse scored. Item scores are summed to create scale scores.

Original Citation

Shin, H., Park, Y. J., & Cho, I. (2018). Development and psychometric validation of the Menstrual Health Instrument (MHI) for adolescents in Korea. Health Care for Women International, 39(10), 1090-1109.

Psychometric Score

Ease of Use Score

Scoring breakdown

Formative Research

Qualitative Research

Existing Literature/Theoretical Framework

Field Expert Input

Cognitive Interviews / Pilot Testing








Criterion (gold-standard)



Ease of Use


Scoring Clarity


Join the EMERGE Community

to get the latest updates on new measures and guidance for survey researchers