The Underlying Truth of Dysmenorrhea

Menstrual cramps have been an ongoing inconvenience for women, only acknowledged as a medical problem in the late 1970s. Painful periods without an underlying cause are referred to as “Primary Dysmenorrhea.” Due to recent attention, there has been a significant lack of information on dysmenorrhea, with many not knowing the true effects that dysmenorrhea has on millions of women’s lives. These effects interconnect, but can still be separated into five categories: physical, lifestyle, academic, cultural and psychological effects.

Dysmenorrhea occurs when the uterus contracts to shed the endometrial (inner uterus) lining, which causes physical symptoms. Although a cause-and-effect relationship has not been identified, overproduction of inflammatory hormones such as prostaglandins, vasopressin, leukotrienes, and others strongly correlates with pain severity and duration.

The initial thought is radiating pain in the abdomen; however, many women have reported lower back pain, headaches, muscle cramps and pain along the thighs.

Aside from body pains, dysmenorrhea can result in a loss of appetite or poor digestion, which can lead to symptoms such as nausea, vomiting and diarrhea, even due to the intensity of pain.

Many of these physical dysmenorrhea symptoms are experienced monthly by women, which can significantly impact their lifestyle, including:

• Avoiding physical activities

• Sleep disturbances due to pain intensity

• Strain on relationships due to the lack of understanding of this issue

  
  

A study was conducted on 1720 Romanian medical students that shows the impacts on lifestyle, as 63.4% of the students reported that dysmenorrhea impacted their quality of life & relationships.

Dysmenorrhea has also affected women academically in school and the workplace, as it is the main cause of absence from school/work. Women — ages 14-20 — reported dysmenorrhea to be the cause of their monthly absences. The intensity of dysmenorrhea varies from person to person, but it can cause uneasiness and lack of concentration. This can lead to an inadequate ability to absorb information, resulting in poor academic performance and individual study.

Cultural factors are the main reason why dysmenorrhea and women’s health in general are understudied. The perspective ethnic groups have on dysmenorrhea & menstruation can directly impact the level of dysmenorrhea a woman may experience. This is because suppressing pain can increase psychological stress, leading to increased dysmenorrhea symptoms.

• Developing countries generally have less research on dysmenorrhea since the topic is often taboo and stigmatized, so awareness and education are minimal compared to Western cultures.

• In Hindu culture, dysmenorrhea would be seen as unpreventable since there are cultural rules enforced upon it, leading to psychological stress.

• In Islamic law, menstruating women cannot pray, fast or engage in sexual intercourse, isolating them from their culture.

• In African communities, such as Uganda, dysmenorrhea is normalized in school children because labour pain is worse. 

  
  

Other effects can lead to loss of self-esteem, social withdrawal from mood swings & irritability, and in severe cases, depression.

Risk Factors

Several risk factors influence the symptoms and severity of dysmenorrhea, which include:

Body fat and fitness:

• Too much body fat, particularly around the organs, is linked to a longer duration of pain and higher intensity

• Low body fat, which is common in athletes, is linked to an increase in pain intensity

• Higher cardiorespiratory fitness has also been shown to reduce dysmenorrheic symptoms as it increases blood flow and relaxes muscles

  
  

Diet:

• High fibre and low fat diets reduce estrogen levels, which reduces uterine lining thickness and prostaglandin production.

• Participants in a study who were given a low-fat vegan diet had less pain during menstruation due to decreased estrogen.

• Many animal products increase estrogen concentration, which increases the type of prostaglandins mainly found in people with dysmenorrhea.

  
  

Psychological stress:

Along with the effects it has on the daily lives of people with dysmenorrhea, it has been shown to alter brain structures responsible for stress and mood regulation. This leads to higher pain sensitivity, as well as increased susceptibility to stress and a struggle to manage negative feelings, leading to chronic stress. Over time, the brain struggles to stay balanced, leading to irritability, mood swings, and sometimes anxiety and depression.

Depression:

Studies found that dysmenorrhea contained the same genetic markers as depression (SNPs — biological markers found in DNA so scientists can find genes linked to a disease), as the link was evident in Europeans to increase risk, but mixed in Asians.

The two genetic markers were shown to be biologically connected by looking at them together. This is because genetic markers that were related to depression affected genes in the brain, thyroid, ovaries and adrenal glands, which are all parts of the body’s stress and hormonal systems, responsible for mood and overall reproductive health.

The study also found that certain lifestyles of those with depression increased the risk of dysmenorrhea, such as a lack of sleep, acting as a link between depression and dysmenorrhea.

Smoking and Alcohol:

A key risk factor that has proven to be linked to intensifying the symptoms of dysmenorrhea is smoking and alcohol consumption. Smoking worsens menstrual pain through:

• Nicotine-induced vasoconstriction — nicotine forces blood vessels to constrict. The narrowing of the blood vessels reduces the amount of blood flow in the uterus, which increases prostaglandin production

• Alcohol: affects hormone levels and creates hormone imbalance, increases inflammation, and impacts sleep and hydration

  
  

A study was conducted with a sample of 8567 women. It was found that those who used both were most likely to experience severe symptoms (18.6%), while non-users only made up 7.5% of those with dysmenorrhea.

The study also stated that it could have been due to lifestyle choices:

• Users of both having more caffeine intake and less exercise

• Non-users were more likely to be vegetarian, minimizing the symptoms through a cleaner diet

  
  

Although dysmenorrhea affects a large percentage of women, it is not fully understood and sufficiently researched. Much of the research for this condition is geared more towards treatments to alleviate the symptoms rather than tackle the root cause, which is like putting a bandaid over a gunshot, metaphorically causing your whole body to bleed rather than just your uterus! 

References

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Evans, J., & Salamonsen, L. A. (2012). Inflammation, leukocytes and menstruation. Reviews in Endocrine and Metabolic Disorders, 13(4), 277–288. https://doi.org/10.1007/s11154-012-9223-7 

Francavilla, R., Maddalena Petraroli, Messina, G., Stanyevic, B., Arianna Maria Bellani, Susanna MR Esposito, & Street, M. E. (2023). Dysmenorrhea: Epidemiology, Causes and Current State of the Art for Treatment. Clinical and Experimental Obstetrics & Gynecology, 50(12), 274–274. https://doi.org/10.31083/j.ceog5012274 

Kuo, C.-S., Wang, K.-T., Lai, J. C.-Y., & Chen, S.-J. (2025). Influence of tobacco smoking and alcohol drinking on dysmenorrhoea: a cross-sectional analysis of data from the Taiwan Biobank. BMJ Open, 15(2), e088537–e088537. https://doi.org/10.1136/bmjopen-2024-088537 

Liu, J., Liu, H., Mu, J., Xu, Q., Chen, T., Dun, W., Yang, J., Tian, J., Hu, L., & Zhang, M. (2017). Altered white matter microarchitecture in the cingulum bundle in women with primary dysmenorrhea: A tract-based analysis study. Human Brain Mapping, 38(9), 4430–4443. https://doi.org/10.1002/hbm.23670 

Liu, S., Wei, Z., Carr, D. F., & Moraros, J. (2024). Deciphering the genetic interplay between depression and dysmenorrhea: A Mendelian randomization study. Briefings in Bioinformatics, 26(1). https://doi.org/10.1093/bib/bbae589 

Nagy, H., & Khan, M. A. (2023). Dysmenorrhea. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560834/ 

Rizki Purwaningtyas, D., Fitriani, A., & Darmawansyah Alnur, R. (2025). The relationship between body composition and physical fitness with primary dysmenorrhea among adolescents in urban areas. BIO Web of Conferences, 153(153), 01003. https://doi.org/10.1051/bioconf/202515301003