Study dataset used for the analysis.

Primary dysmenorrhea (PD) is prevalent among adolescent girls but understudied in rural Pakistan. This study examines the prevalence of PD and its associated factors among girls aged 10–19 in a rural district of Pakistan. A cross-sectional survey was conducted in the district of Tando Mohammad Khan (TMK) among post-menarchal girls aged 10–19 using a multistage cluster random sampling. Analyses were conducted using STATA 15.0, with multivariable logistic regression adjusted for survey weights. Among 405 participants, 60.4% (95% CI [54–66]) reported PD. Higher body mass index was associated with reduced odds (overweight/obese: AOR = 0.3, 95% CI [0.1–0.9]), while lifestyle factors like physical inactivity (AOR = 1.8, 95% CI [1.2–2.9]) and inadequate sleep (AOR = 2.4, 95% CI [1.2–3.8]), increased PD odds. Dietary intake data suggested that each 10 g increase in carbohydrate slightly raised (AOR = 1.0, 95% CI [0.9–1.1]), whereas every 1 mg increase in vitamin B6 reduced PD odds (AOR = 0.9, 95% CI [0.8–0.9]). Menstrual hygiene practices like changing pads less frequently than 6 hours increased PD odds (AOR = 2.1, 95% CI [1.3–3.4]), while cloth pad reuse was associated with lower odds (AOR = 0.6, 95% CI [0.4–1.0]). PD prevalence is high among adolescents in TMK, with higher BMI linked to reduced PD odds, while diet, lifestyle, and menstrual hygiene significantly influence menstrual health. Further research is needed to guide targeted interventions for adolescent girls’ well-being and to promote gender equity.