Primary dysmenorrhea pain profile among Brazilian women. Case-control study

Rafael, Flávia Rezende Moura Mesquita; Bertolini, Natalia Oliveira; Silva, Samuel; Vilella, Renato Carvalho

doi:10.5935/2595-0118.20250001-en

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ORIGINAL ARTICLE • BrJP 8 • 2025 • https://doi.org/10.5935/2595-0118.20250001-en linkcopy

Primary dysmenorrhea pain profile among Brazilian women. Case-control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES: Primary dysmenorrhea (PD) is defined as lower abdominal pain occurring before or during menstruation, unrelated to other diseases. Existing studies investigating potential risk factors for PD development and its incidence in various groups have been fragmented, controversial, or overly broad, posing challenges for analysis. Therefore, this study aims to identify potential risk factors for PD development through a literature-based case-control study.

METHODS: Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), this one-year case-control study aimed to establish relationships between PD variables and pain categories (light, moderate, and severe) among 252 Brazilian women.

RESULTS: The regularity of the menstrual cycle, intensity of menstrual flow, seeking medical assistance, and use of pain drugs demonstrated statistical significance (p=0.00) across different pain categories. Conversely, factors such as smoking, alcohol consumption, daily diet, physical activity, regular menstrual cycle, previous pregnancy, active sex life, family history of PD, pain site, and the time of onset of PD after the first menstrual cycle were not statistically significant within the pain categories. Although no statistical significance was observed, certain observations can still be drawn by comparing this study with similar ones.

CONCLUSION: This study offers valuable insights into the risk factors, pain intensity, menstrual flow patterns, and treatment-seeking behavior associated with PD. By addressing these factors and improving our understanding of PD, we can enhance the well-being and quality of life of women affected by this common gynecological condition.

Keywords:
Dysmenorrhea; Menstrual cycle; Pelvic pain

HIGHLIGHTS

Menstrual flow intensity is proportional to menstrual pain intensity.

Women with regular menstrual cycles tend to experience more menstrual pain.

Physiotherapy can be an excellent alternative to reduce menstrual pain.

Variables	Levene statistic	p-value
Age (years)	0.845	0.431
Smoker	2.941	0.055
Alcohol intake	1.000	0.370
Healthy food intake	1.301	0.274
Regular physical activity	2.967	0.053
Age at first menstrual cycle (years)	1.110	0.331
Regular menstrual cycle	24.592	0.000
Menstrual flow (bleeding)	10.960	0.000
Time of appearance of primary dysmenorrhea after first menstrual cycle	2.615	0.075
Previous pregnancy	2.126	0.121
Active gender life	0.938	0.393
PD family history (Sister/Mother)	10.398	0.000
Local pain (uterus region) or referred pain (other regions)?	2.653	0.072
Seek medical assistance	37.721	0.000
Seek physiotherapy assistance	2.201	0.113
Use of drug for pain?	15.880	0.000

Variables	Effect size
Age (years)	0008
Smoker	0 002
Alcohol intake	0.006
Health food intake	0.005
Regular physical activity	0.001
Age at first menstrual cycle (years)	0.001
Regular menstrual cycle	0.04
Menstrual flow (bleeding)	0.09
Time of appearance of primary dysmenorrhea after first menstrual cycle	0.001
Previous pregnancy	0.003
Active gender life	0.006
Primary dysmenorrhea family history (sister/mother)	0.01
Local pain (uterus region) or referred pain (other regions)?	0.01
Seek medical assistance	0.09
Seek physiotherapy assistance	0.003
Use of drug for pain?	0.17

		Dysmenorrhea Categories
Variables	Light pain (n=33)	Moderate pain (n=120)	Severe pain (n=100)	Total (n=253)	p-value
Age (years)	29.12±1.42(26.20:32.03)	27.70±0.69(26.32:29.07)	26.41±0.75(24.91:27.90)		0.130
Age at first menstrual cycle (years)	12.21±0.21(11.77:12.65)	12.55±0.13(12.28:12.81)	12.81±0.21(12.00:12.87)		0.479
Smoker
%Yes	6	6	10	7±2.31(6.72:7.28)	0.168
%No	94	94	90	93±2.31(92.72:93.28)
Alcohol intake
%Yes	42	61	56	53±9.85(51.71:54.71)	0.684
%No	58	39	44	47±9.85(45.79:48.21)
Health food intake
%Yes	61	68	65	65±3.51(64.67:65.43)	0.288
%No	39	32	35	35±3.51(34.57:35.43)
Regular physical activity
%Yes	64	60	51	58±6.66(57.18:58.82)	0.454
%No	36	40	49	42±6.66(41.18:42.82)
Regular menstrual cycle
%Yes	76	83	62	74±10.69(72.68:75.32)	0.0016
%No	24	17	38	26±10.69(24.68:27.32)
Previous pregnancy
%Yes	30	24	21	25±4.58(24.44:25.56)	0.000002
%No	70	76	79	75±4.58(74.44:75.56)
Active gender life
%Yes	85	82	80	82±2.52(81.69:81.31)	0.468
%No	15	18	20	18±2.52(17.69:19.31)
PD Family history (sister/mother)
%Yes	70	80	67	72±6.81(72.16:72.84)	0.547
%No	30	20	33	28±6.81(27.16:28.84)
Seek medical assistance
%Yes	15	40	62	39±23.52(36.10:41.90)	0.794
%No	85	60	38	61±23.52(58.10:64.90)
Seek physiotherapy assistance
%Yes	0	1	2	1±1(0.88:1.12)	0.082
%No	100	99	98	99±1(98.88:99.12)
Local pain (uterus region) or referred pain (other regions)?
% Local	64	46	42	51±11.72(49.56:52.44)	0.095
% Referred	36	54	58	49±11.72(48.56:50.44)
Menstrual flow (bleeding)
%Light	42	18	11	24±16.25(22.00:26.00)	0.0000045
%Moderate	42	64	44	50±12.16(48.51:51.49)
%Severe	16	18	45	26±16.19(24.01:27.99)
Time of appearance of PD after first menstrual cycle
%Before one month	27	36	49	37±11(36.00:38.00)	0.581
%Between one month and six months	45	33	20	33±13(32.40:34.60)
%Between six months and one year	10	10	6	9±2(8.75:9.25)
%After one year	18	21	25	21±4(20.51:21.49)
Use of drugs for pain?
%Do not use drug	27	13	3	14±12(12.52:15.48)	0.0000000002
%Use drug and relieve pain	73	78	59	70±9.84(68.79:71.21)
%Use drug and does not relieve pain	0	9	38	16±19.85(13.55:18.45)

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[TFN1] Data are the mean ± standard deviation (95% CI). Variables were compared between dysmenorrhea categories (light pain, moderate pain, and severe pain) using the Kruskal-Wallis H test.