Research
General gynecology
The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors

Presented in poster format at the 59th annual meeting of the Society for Gynecologic Investigation, San Diego, CA, March 21-24, 2012.
https://doi.org/10.1016/j.ajog.2013.08.020Get rights and content

Objective

The factors that underlie pelvic pain are poorly understood. Specifically, the relative influence of dysmenorrhea and psychological factors in the etiology of noncyclic pelvic pain conditions, such as interstitial cystitis and irritable bowel syndrome, is unknown. To further characterize pelvic pain, we compared the frequency of menstrual, somatosensory, and psychological risk factors between women with and without severe noncyclic pelvic pain symptoms.

Study Design

A total of 1012 reproductive-aged women completed a 112-item questionnaire with domains including mood, fatigue, physical activity, somatic complaint, and pain. Questionnaire items included existing items for menstrual distress and newly written items derived from qualitative interviews. The relationship of dysmenorrhea and noncyclic pelvic pain complaints (dyspareunia, dyschezia, or dysuria) was modeled using quantile regression.

Results

Among women who menstruate regularly, those with dysmenorrhea had disproportionally more severe noncyclic pelvic pain (54/402, 13%) than women without dysmenorrhea (5/432, 1%; odds ratio, 13; 95% confidence interval, 5–33). In a multivariate-adjusted model, dysmenorrhea (β = .17), activity capability (β = .17), somatic complaint (β = .17), and bodily pain (β = .12) were the primary predictors of noncyclic pelvic pain. Depression (β = .03) and anxiety (β = .01) were not significantly predictive. The presence of dysmenorrhea, somatic complaint, and low activity capability predicted 90% of the cases of women with noncyclic pelvic pain.

Conclusion

The association between dysmenorrhea and noncyclic pelvic pain suggests that menstrual pain is an etiological factor in noncyclic pelvic pain, whereas depression and anxiety may be secondary effects. Longitudinal studies are needed to determine whether dysmenorrhea causally influences development of noncyclic pelvic pain or shares common underlying neural mechanisms.

Section snippets

Materials and Methods

The NorthShore University HealthSystem Institutional Review Board approved all phases of this study. We obtained a waiver of written informed consent due to the anonymous nature of participation.

Data in this study were originally collected as part of the development of a self-report measure of menstrual distress. We followed the strengthening the reporting of observational studies in epidemiology (STROBE) requirements for cross-sectional studies18 and guidelines for self-report measures.19 In

Results

Seventy-one subjects met the criteria for noncyclic pelvic pain. The remaining 941 participants served as controls for the purposes of our analyses. This community-based sample was diverse with regard to socioeconomic and racial status: 55% of the subjects participating in this survey had below the median household US income ($51,413) and our cohort included 17% racial minorities. There were no significant differences in menstrual phase at the time of participation, income, or education between

Comment

Our findings indicate that menstrual pain, even after controlling for depression and anxiety, is associated with the severity of noncyclic pelvic pain. Additionally, self-reported pain complaints in other systems are associated with the magnitude of noncyclic pelvic pain. Thus, our findings provide strong support for involvement of neurophysiological end-organ dysfunction, such as dysmenorrhea, as opposed to psychological dysfunction, in noncyclical pelvic pain.

Our cross-sectional study is

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  • Cited by (0)

    Financial support for this work was provided by the NorthShore University HealthSystem Clinical Collaborative Research Program (F.T., J.W.G.), National Institutes of Health grant K23HD054645 (F.T.).

    The authors report no conflict of interest.

    Reprints not available from the authors.

    Cite this article as: Westling AM, Tu FF, Griffith JW, et al. The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors. Am J Obstet Gynecol 2013;209:422.e1-10.

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