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

Abstract

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.

Noninvasive experimental bladder pain assessment in painful bladder syndrome

“…Since self-reported symptom indices are vulnerable to somatization and psychological factors, complete phenotypic assessment of pain states ideally includes symptom-based and unbiased experimental visceral pain assessment. 8,22,23 Third, we used a positive control group without significant bladder symptoms to untangle potential pain and urgency relationships on visceral pain sensitivity.…”

The prevalence and potential determinants of dysmenorrhoea and other pelvic pain in women: a prospective study

“…Pelvic pain conditions are associated with increased pain sensitivity due to central changes in the nervous system, as well as other factors that affect the neurobiology of pain (e.g. sleep fragmentation) .…”

A possible link between dysmenorrhoea and the development of chronic pelvic pain

“…showed that 81% of women with CPP also experience dysmenorrhoea. A study by Westling et al . also found a significant association between dysmenorrhoea and noncyclic pelvic pain (defined as dyspareunia, dyschezia or dysuria), suggesting that dysmenorrhoea may be an aetiological factor.…”