MacGregor, B., Allaire, C., Bedaiwy, M. A., Yong, P. J., & Bougie, O. (2023). Disease Burden of Dysmenorrhea: Impact on Life Course Potential. International journal of women's health. https://doi.org/10.2147/ijwh.s380006
MacGregor B, Allaire C, Bedaiwy MA, Yong PJ, Bougie O. Disease Burden of Dysmenorrhea: Impact on Life Course Potential. International journal of women's health. 2023. doi:10.2147/ijwh.s380006
MacGregor, Brittany, et al. "Disease Burden of Dysmenorrhea: Impact on Life Course Potential." International journal of women's health, 2023.
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Dysmenorrhea can limit school, work and relationships over a lifetime
A 2023 narrative review of published studies argues that painful periods, called dysmenorrhea, can limit school, work and relationships across a person's life. The authors drew on research from teens and adults in many countries. One meta-analysis of over 20,000 young women in 38 countries found 71.1% had dysmenorrhea.
Key Findings
A meta-analysis covering over 20,000 young women from 38 countries put the prevalence of dysmenorrhea at 71.1%.
An earlier systematic review found 20.1% missed school or university because of dysmenorrhea, and 40.9% said it hurt their classroom performance or concentration.
In a Japanese insurance database, health-care costs ran 2.2 times higher with primary dysmenorrhea and 2.9 times higher with secondary dysmenorrhea than in matched controls, after adjustment.
A meta-analysis linked a past of painful periods to a 2.5 times higher chance of later chronic pain, both pelvic and elsewhere.
In a Hungarian internet survey of 1836 participants with dysmenorrhea, 70% reported an impact on work, study and social activities, and 16% reported extreme impact.
Interpretation
The 2.5 times higher rate of later chronic pain comes from a meta-analysis that linked dysmenorrhea to chronic pelvic pain and to pain in other parts of the body. The authors point to a process called hyperalgesic priming. In this process, repeated pain signals make the nervous system more sensitive over time. They say this may help explain how recurrent dysmenorrhea leads to chronic pain. The authors note that estimates of how common dysmenorrhea is ranged widely, from 1.7% to 97%, across 106 studies in a World Health Organization review. They attribute that wide range to differing definitions of the condition and its severity. The findings support further research into managing menstrual pain early to help prevent chronic pain later in life.
RRM Context
The review lists combined hormonal contraceptives among first-line drugs. Suppressive medications like these lower prostaglandins by suppressing ovulation. Restorative reproductive medicine starts by looking for the cause. The review also calls for tests to sort primary dysmenorrhea from causes like endometriosis and adenomyosis. The authors report that up to 70% of teens who did not respond to first-line treatments had signs of endometriosis on laparoscopy.
Our editorial summary of this paper, not the article's abstract.
Abstract
Dysmenorrhea is the most common gynecologic condition among the female population and has a significant impact on life course potential. It has a widespread impact on a female's mental and physical well-being, with longstanding impairments on quality of life, personal relationships, and education and career attainment. Furthermore, untreated dysmenorrhea can lead to hyperalgesic priming, which predisposes to chronic pelvic pain. Primary dysmenorrhea is pain in the lower abdomen that occurs before or during menses and in the absence of pelvic pathology. One possible mechanism is endometrial inflammation and increased prostaglandin release, resulting in painful uterine contractions. Dysmenorrhea may also occur secondary to pelvic pathology, such as endometriosis, adenomyosis or due to cyclic exacerbation of non-gynecologic pain conditions. A thorough patient evaluation is essential to differentiate between potential causes and guide management. Treatment must be tailored to individual patient symptoms. Pharmacologic management with non-steroidal anti-inflammatory medications and/or combined hormonal contraceptives is most common. Heat therapy, exercise, vitamins and dietary supplements have limited evidence and can be offered for patients seeking non-pharmacologic adjunctive or alternative options. Greater awareness for both health-care providers and patients allows for early intervention to reduce impact on quality of life and life course potential.
