BACKGROUND: Menstrual health encompasses a holistic state of physical, mental, and social well-being rather than simply the absence of illness associated with the menstrual cycle. It touches all aspects of human life. However, few tools are available to comprehensively examine the various areas of menstrual health. This study aimed to assess the psychometric properties of the menstrual health instrument (MHI). METHOD: This study employed a cognitive method to psychometrically evaluate the English version of the Menstrual Health Questionnaire. This questionnaire consists of 29 items and 5 domains, including Affective symptoms, Somatic symptoms, school life, Daily habits for menstrual health, Menstrual cycle characteristics, Attitudes and perceptions on menstruation. It was conducted on 412 adolescent girls aged 13 to 18 from high schools in Babol City in 2023. Confirmatory and exploratory factor analyses were conducted in this study. RESULTS: A total of 412 adolescent girls from girls' high schools in Babol City participated in this study. The mean age and mean age of menarche in participants were 14.20 ± 0.80 and 12.14 ± 0.99, respectively. The highest correlation among the 5 scales of the Menstrual Health Questionnaire was observed between emotional symptoms and physical symptoms and daily activities (r = 0.736, p <
0.001). In the content validity quantitative phase, all items of the original 29-question questionnaire had appropriate CVR and CVI and were retained in the study. The results of confirmatory factor analysis of the original questionnaire indicated that the hypothesized model has a reasonably good fit (Chi-square statistic = 846.09, CFI = 0.93, RMSEA = 0.057). The overall Cronbach's alpha was 0.87. Finally, in the exploratory factor analysis within the same population for the initial 29 questions, 17 questions remained with 3 factors at the end of the structural validity phase, which explained 64.52% of the variance. CONCLUSION: The Persian version of the menstrual health questionnaire, with three extracted factors, demonstrates appropriate validity and reliability for use in studies related to menstrual health among Iranian girls.