Epidemiology

Pain is a common complaint of menstruating women. It is often disregarded by many of these women who consider pain to be a normal part of the menstrual cycle. Thus, many women fail to report their pain to the physicians who treat them. The consequences of untreated primary dysmenorrhea range from lost work and school hours to family and personal disruption. However the medical community has only recently acknowledged dysmenorrhea as an important women’s health issue, calling for further research into the pathophysiology, epidemiology, and socio-economic implications of this disease.

Prevalence

Prevalence rates reported for dysmenorrhea vary greatly from study to study, probably as greatly as the methods of collecting data, the study definitions of dysmenorrhea and pain, and the study populations themselves. Prevalence rates have been reported to be as high as 90% and as low as 43% [Jamieson, 1996; Svanberg, 1981]. Some studies have attempted to distinguish between primary and secondary dysmenorrhea, while others have not.

The table below, with data organized by study date, shows the wide variation in prevalence rates in selected studies.

Studies of Prevalence of Dysmenorrhea in Different Populations

Publication date Prevalence Author Sample size Population description Geographic location

2000 85% Banikarim, Chacko, Kelder 706 Hispanic females in 9th to 12th grades Houston, Texas

2000 57.5% Chen et al. 388 Newlywed females Shenyang, China

1999 80% Hillen et al. ** 384 Females 15 to 17 years old (grades 11 and 12) Perth, Western Australia

1998 57% Gürel, Gürel* 235 Premenstrual females 18 to 56 years old Turkey

1996 71.6% Harlow, Park 165 Females 17 to 19 years old enrolled at local university Ann Arbor, Michigan

1996 90% Jamieson, Steege 533 Menstruating females 18 to 45 years old North Carolina

1993 > 70% Messing et al. 726 Menstruating females in 17 poultry slaughterhouses and 6 canneries Western France

1992 51.3% Ng, Tan, Wansaicheong 415 Females 15 to 54 years old Singapore

1992 79.6% Robinson et al. 308 Primarily black females, average age 16 Baltimore, Maryland

1990 67% Sundell, Milsom, Andersch 489 24-year-old females Sweden

1990 72.3% Thomas, Okonofua, Chiboka 768 Female students 15 to 34 years old Obafemi Awolowo University, Nigeria

1988 53% Pullon, Reinken, Sparrow 1826 Female patients at outpatient clinic,16 to 54 years old Wellington, New Zealand

1985 44% to 64%, according to postmenarchal age Flug, Largo, Prader 140 Females 12 to 20 years old Switzerland

1982 72.4% Andersch, Milsom 596 19-year-old females Gothenburg, Sweden

1981 59.7% Klein, Litt 2699 Females 12 to 17 years old United States

1981 43% Svanberg, Ulmsten 502 Females 10 to 19 years old Malmö, Sweden

1978 89% Sobczyk et al. 113 Females in patient records Charleston, South Carolina

1975 61% Bergsjø, Jenssen, Vellar** 234 Female industrial workers of menstruating age Oslo and Bergen, Norway

1971 8% in girls <14 years old to 26% in the 5th gynecological year Widholm, Kantero 16096 8111 females 10 to 20 years old; 7985 mothers, mean age 40 Finland

* Those with secondary dysmenorrhea specifically excluded
** Primary and secondary dysmenorrhea differentiated, but those with secondary dysmenorrhea not excluded from study

Risk Factors for Primary Dysmenorrhea

Many studies have addressed a potential correlation between primary dysmenorrhea and age at menarche, current age, parity, marital status, occupation, physical fitness, weight, smoking, and the use of alcohol. However, the conclusions of these studies are not definitive and often contradict one another.

The table below, with data organized by study date, shows findings in selected studies regarding risk factors.

Studies of Prevalence of Dysmenorrhea in Different Populations

Publication date Risk factors Author Sample size Population description Geographic location

2000 Dose-response relationship found between environmental tobacco smoke and increased incidence of dysmenorrhea Chen et al. 388 Newlywed females Shenyang, China

1998 No risk associated with age, parity, abortion, or length of marriage Gürel, Gürel 235 Premenstrual females 18 to 56 years old Turkey

1996 Increased risk of occurrence, duration, and severity of pain associated with menarche at early age, menses >7 days, cycle length, overweight, and smoking; frequent alcohol consumption decreased probability of having pain, but increased odds of having severe pain and pain lasting >2 days Harlow, Park 165 Females 17 to 19 years old enrolled at local university Ann Arbor, Michigan

1994 Increased risk associated with smoking: relative risk increases with number of cigarettes smoked/day and duration of smoking; decreased risk associated with heavy alcohol consumption Parazzini 251 106 females with dysmenorrhea and 145 controls 15 to 44 years old Milan, Italy

1993 Increased risk associated with young age, smoking, use of IUDs, certain working conditions, such as cold, humidity, and drafts; decreased risk associated with use of oral contraceptives; no change in risk associated with parity or body weight Messing et al. 726 Menstruating females in 17 poultry slaughterhouses and 6 canneries Western France

1992 Decreased risk associated with increased age (>30), menarche at age >12, being parous; no risk associated with physical activity Ng, Tan, Wansaicheong 415 Females 15 to 54 years old Singapore

1992 Decreased risk associated with being parous Robinson et al. 308 Primarily black females, average age 16 Baltimore, Maryland

1991 Decreased risk associated with athletic activity Izzo, Labriola 764 Two groups of female athletes 16 to 23 years old Italy

1990 Increased risk associated with menarche early age, increasing duration of menses, smoking; decreased risk with use of oral contraceptives, being parous; no risk associated with use of IUDs, height, weight, length of cycle, or physical exercise Sundell, Milsom, Andersch 489 24-year-old females Sweden

1988 Increased risk associated with age <25, shorter length of cycle, smoking, nulliparity; decreased risk associated with use of oral contraceptives; no change in risk associated with physical activity associated with occupation or body mass Pullon, Reinken, Sparrow 1826 Female patients at outpatient clinic,16 to 54 years old Wellington, New Zealand

1982 Increased risk associated with menarche at early age, nulliparity, duration of menses, amount of menses, and mothers and sisters with dysmenorrhea; decreased risk associated with use of oral contraceptives, smoking; no change in risk associated with height, weight, length of cycle Andersch, Milsom 596 19-year-old females Gothenburg, Sweden

1981 Increased risk associated with increasing socio-economic status; no change in risk associated with race or reported preparation for menarche Klein, Litt 2699 Females 12 to 17 years old United States

1981 Increased risk associated with age >13 Svanberg, Ulmsten 502 Females 10 to 19 years old Malmö, Sweden

1971 Increased risk associated with maternal dysmenorrhea; decreased risk associated with no maternal dysmenorrhea Widholm, Kantero 16096 8111 females 10 to 20 years old; 7985 mothers, mean age 40 Finland

Socio-Economic Impact

A number of studies have addressed the socio-economic impact of dysmenorrhea, such as absenteeism from work and school, as well as disruption of social and athletic activities.

The table below, with data organized by study date, shows the socio-economic impact of dysmenorrhea in selected studies

Socio-Economic Impact of Dysmenorrhea in Different Populations

Publication date Socio-economic impact Author Sample size Population description Geographic location

2000 38% absenteeism; activities such as class concentration, daily chores, sports, class participation, socialization, test-taking skills, homework, and grades affected Banikarim, Chacko, Kelder 706 Hispanic females in 9th to 12th grades Houston, Texas

1999 52% reported limitation of activities such as school, sports, social Hillen et al. 384 Females 15 to 17 years old (grades 11 and 12) Perth, Western Australia

1992 52% of students, 41% of employed women, and 30% of housewives reported ability to work affected Ng, Tan, Wansaicheong 415 Females 15 to 54 years old Singapore

1990 34% absenteeism (absenteeism significantly reduced since 1982 study--see Andersch, Milsom, below) Sundell, Milsom, Andersch 489 24-year-old females Sweden

1982 51% absenteeism Andersch, Milsom 596 19-year-old females Gothenburg, Sweden

1981 14% frequently missed school Klein, Litt 2699 Females 12 to 17 years old United States

1975 31% absenteeism Bergsjø, Jenssen, Vellar 234 Female industrial workers of menstruating age Oslo and Bergen, Norway

References

Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol. 1982;144:655-660.

Banikarim C, Chacko MR, Kelder SH. Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Arch Pediatr Adolesc Med. 2000;154:1226-1229.

Bergsjø P, Jenssen H, Vellar OD. Dysmenorrhea in industrial workers. Acta Obstet Gynecol Scand. 1975;54:255-259.

Chen C et al. Prospective study of exposure to environmental tobacco smoke and dysmenorrhea. Environ Health Perspect. 2000;108:1019-1022.

Flug D, Largo RJ, Prader A. Symptoms related to menstruation in adolescent Swiss girls: a longitudinal study. Annals Hum Biol. 1985;12(2);161-168.

Gürel H, Gürel SA. Dyspareunia, back pain, and chronic pelvic pain: the importance of this pain complex in gynecological practice and its relation with grandmultiparity and pelvic relaxation. Gynecol Obstet Invest. 1999;48:119-122.

Harlow SD, Park M. A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol. 1996;103:1134-1142.

Hillen TIJ et al. Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment. J Adolesc Health. 1999;25:40-45.

Izzo A, Labriola D. Dysmenorroea and sports activities in adolescents. Clin Exp Obst Gyn. 1991;18(2):109-116.

Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996;87(1):55-58.

Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics. 1981;68(5):661-664.

Messing K et al. Factors associated with dysmenorrhea among workers in French poultry slaughterhouses and canneries. J Occup Med. 1993;35(5):493-500.

Ng TP, Tan NCK, Wansaicheong GK. A prevalence study of dysmenorrhoea in female residents aged 15-54 years in Clementi Town, Singapore. Ann Acad Med Singapore. 1992;21(3):323-327.

Parazzini F et al. Cigarette smoking, alcohol consumption, and risk of primary dysmenorrhea. Epidemiology. 1994;5(4):469-472.

Pullon S, Reinken J, Sparrow M. Prevalence of dysmenorrhoea in Wellington women. NZ Med J. 1988;101:52-54.

Robinson JC et al. Dysmenorrhea and use of oral contraceptives in adolescent women attending a family planning clinic. Am J Obstet Gynecol. 1992;166:578-83.

Sobczyk R et al. A case control survey and dysmenorrhea in a family practice population: a proposed disability index. J Fam Pract. 1978;7(2):285-290.

Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol. 1990;97:588-594.

Svanberg L, Ulmsten U. The incidence of primary dysmenorrhea in teenagers. Arch Gynecol. 1981;230:173-177.

Thomas KD, Okonofua FE, Chiboka O. A study of the menstrual patterns of adolescents in lle-lfe, Nigeria. Int J Gynecol Obstet. 1990;33:31-34.

Widholm O, Kantero R-L. A statistical analysis of the menstrual patterns of 8,000 Finnish girls and their mothers. Acta Obstet Gynecol Scand. 1971(Suppl.);14:1-36.

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