Background <p>Nursing students are future nurses. They are more susceptible to the physiological and psychological implications of climate change because of their participation in climate activities.</p> Aim <p>To assess the relationships among nursing students’ climate change awareness, climate change-related stress and eco-anxiety; and the associations between their climate change-related stress and their eco-anxiety and premenstrual syndrome.</p> Methods <p>A cross-sectional correlational study was conducted on a convenience sample of 400 female nursing students at Matrouh University via self-report questionnaires about climate change knowledge and awareness, perceived stress, eco-anxiety and premenstrual syndrome. The data were collected from January 2022 to June 2025. Hierarchical multiple regression analysis was performed to analyze the effects of the mediating and moderating variables.</p> Results <p>Nursing students demonstrated satisfactory levels of knowledge and high levels of awareness of climate change. High climate change awareness among nursing students was coupled with moderate (53.2%) to severe (28.6%) climate change-related stress, whereas 54.9% of the students experienced moderate (46.2%) to severe (8.7%) levels of eco-anxiety. Regression analysis revealed that the relationship between nursing students’ climate change-related stress and eco-anxiety was moderated via climate change awareness as a moderating factor. Eco-anxiety played a mediating role in the relationship between climate change-related stress and premenstrual syndrome among nursing students.</p> Conclusion <p>Nursing students suffer from mental stress related to climate change, including climate change-related stress and eco-anxiety, due to increased climate change awareness. Climate change-related stress and eco-anxiety increased the prevalence of premenstrual syndrome among nursing students.</p>