Abstract
BACKGROUND: The relationships of menstrual characteristics with non-suicidal self-injury (NSSI), a potential precursor to suicidal behaviors, have rarely been explored. Therefore, we aimed to examine the associations between menstrual characteristics with NSSI among college students in China. METHODS: A cross-sectional study was conducted among students from six universities randomly chosen from 57 universities in Shaanxi province, China, using a multistage, random cluster sampling method. Menstrual characteristics including menarche age, menstrual cycle length, and menstrual cycle regularity were evaluated using a self-designed questionnaire, and NSSI was assessed using the Chinese adaptation of Ottawa Self-Injury Inventory. Binary logistic regression models were employed to examine the relationships between menstrual characteristics and NSSI. RESULTS: A total of 12,192 female students were included in this study. The prevalence of early menarche (≤ 11years), prolonged menstrual cycles (≥ 32 days), and irregular menstrual cycles was 6.7%, 10.2%, and 13.2%, respectively. After adjusting for potential confounders, participants with early menarche (OR, 1.38; 95% CI, 1.03–1.83), prolonged menstrual cycles (OR, 1.57; 95% CI, 1.23-2.00), and irregular menstrual cycles (OR, 1.48; 95% CI, 1.17–1.86) had significantly increased odds of engaging in NSSI in the past 12 months. Moreover, the likelihood of engaging in NSSI increased as the score of menstrual problems increased (P for trend < 0.001). CONCLUSIONS: Our findings suggest that early menarche, prolonged and irregular menstrual cycles were associated with elevated likelihood of engaging in NSSI. These results emphasize the need for early awareness and monitoring by families, teachers, and healthcare professionals to address the potential adverse associations between menstrual difficulties and NSSI. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-23260-8.