Severity of dysmenorrhea is correlated with overall elevated pain report

Abstract

Objective: Dysmenorrhea remains a poorly understood risk factor for chronic pelvic pain (CPP). One in every five women with menstrual pain will develop a CPP disorder such as endometriosis, interstitial cystitis, or irritable bowel syndrome, but menstrual pain has largely been ignored as a potential target for risk reduction. As part of a broader survey, we investigated the relationship of dysmenorrhea to 7 CPP-like pains: bladder, intercourse, urination, bowel, abdominal, pelvic, and overall pain categories. Methods: A web-based online assessment of non-pregnant women (age 18-45) was administered. Demographic questions and menstrual timing questions were queried, as well as items addressing pertinent constructs based on prior literature and focus group results: fatigue, mood, pain, somatic symptomatology, and physical functioning. Multivariable linear regression was used for statistical evaluation. Results: Among 1021 participants, mean age was 35.06 years old (SD 7.78), with an average parity of 1.3 (SD 1.4). Over 70% of the women reported having a regular, 21-35 day interval menstrual cycle, with the typical menses lasting 5 days (SD 1.54). Over 40% of these subjects indicated moderate or worse dysmenorrhea, and 10% had severe dysmenorrhea. The overall VAS pain score among this cohort at the time of the survey was 2.4 (SD 2.57). The reported severity of dysmenorrhea and the seven different types of CPP-like pain symptoms were significantly correlated (R2=0.19). Only a weak relationship exists between reported pain intensity in these seven pain categories and being on the menses at time of assessment (R2=0.01), suggesting that the severity of dysmenorrhea is associated with regional pain sensitivity throughout the entire menstrual cycle. Multivariable linear regression identified that a combined model that includes anxiety and dysmenorrhea, but not depression best predicts CPP severity (R2=0.35). Discussion: Self- reported intensity of abdomino-pelvic pain in a general population sample of menstruating women is positively associated with dysmenorrhea intensity. Given the well-known phenomenon of cross-organ sensitization, earlier identification of women with more severe dysmenorrhea may permit pre-clinical detection of future CPP patients, opening the door to prevention.