Dietary habits, reproductive and menstrual factors and risk of dysmenorrhoea

An Assessment of Women's Knowledge of the Menstrual Cycle and the Influence of Diet and Adherence to Dietary Patterns on the Alleviation or Exacerbation of Menstrual Distress

A growing number of women of reproductive age experience menstrual disorders. The menstrual cycle is considerably influenced by dietary habits, physical activity, and the use of stimulants. The main aim of this study was to assess women's knowledge about the menstrual cycle and the influence of diet and lifestyle factors on menstrual symptoms, and to identify dietary models that may alleviate or exacerbate menstrual distress. A total of 505 young women participated in the study. Nearly 90% of the respondents reported at least one menstrual disorder, mostly dysmenorrhea (70.7%), whereas secondary amenorrhea was least frequently reported (13.8%) (p = 0.002). In the study population, dysmenorrhea/menstrual distress was linked with higher consumption frequency of certain food groups. Women with severe dysmenorrhea consumed refined cereal products, processed meat, sugar, and water significantly more frequently than women with moderate menstrual pain. In turn, sweetened dairy products, animal fats, and fruit were consumed more frequently by women with low intensity of menstrual pain (mild pain). Significant differences in knowledge about the menstrual cycle and physiological changes in the body were observed between the compared dietary models.

Menstrual cycle irregularity during examination among female medical students at King Abdulaziz University, Jeddah, Saudi Arabia

Background

Menstrual irregularity is defined as any differences in the frequency, irregularity of onset, duration of flow, or volume of blood from the regular menstrual cycle. It is an important medical issue that many medical students suffer from. The study aimed to determine the menstrual cycle abnormalities women experienced during exams and to investigate the most common types of irregularities among female medical students at King Abdulaziz University in Jeddah, Saudi Arabia.

Methods

A cross-sectional study was conducted among female medical students between September and October 2021 at King Abdulaziz University in Jeddah, Saudi Arabia. For this study, the estimated sample size (n = 450) was derived from the online Raosoft sample size calculator. Thus, 450 female medical students from second to sixth year were selected through stratified random sampling. A validated online questionnaire collected data about demographics, menstrual irregularities during exams, type of irregularities, menstrual history, family history of menstrual irregularities, premenstrual symptoms, medication use, medical and family consultations, and absenteeism. The chi-squared test (χ2) was used to analyze the associations between variables.

Results

A total of 48.2% of participants had menstrual irregularities during exams. The most common irregularity was dysmenorrhea (70.9%), followed by a lengthened cycle (45.6%), and heavy bleeding (41.9%). A total of 93% of medical students suffered from premenstrual symptoms and 60.4% used medication such as herbal medication and home remedies to relieve menstrual irregularities, and 12.1% of the students missed classes due to menstrual irregularities. A non-significant relationship was found between menstrual irregularities during exams and students’ demographics, academic year, and age at menarche, while oligomenorrhea, a heavier than normal bleed, a longer than normal cycle, and missing classes due to menstrual irregularities were significantly higher among single students as opposed to married students.

Conclusion

The results showed that female medical students have a significant frequency of menstruation abnormalities during exams period. Colleges should raise awareness among medical students about coping with examination stress and seeking medical care for menstrual abnormalities.

A one-year observational cohort study of menstrual cramps and ovulation in healthy, normally ovulating women

This is a prospective, observational community cohort study with the objective of investigating menstrual cramp occurrence related to ovulatory characteristics. Women reported cramp intensity on daily Menstrual Cycle Diary© records over one year. Ovulation and luteal phase lengths were assessed by validated Quantitative Basal Temperature© (QBT) analysis. Healthy, normal-weight, non-smoking community dwelling premenopausal women ages 21-41 years with two consecutive, normally ovulatory, normal-length menstrual cycles were enrolled. All 53 women, with 13.6 ± 2.8 cycles per woman, reported at least one cramp episode of median intensity 1.5 [0-4 scale; range 1.0-3.5], and 2.2 days' [range 1.0-10.2] duration. Within the 49 women who experienced all ovulatory cycle types (normal, short luteal length [SLL < 10 days] and anovulatory), median cramp intensity was greater in normal-length cycles having subclinical ovulatory disturbances (SLL and anovulatory; median 1.4 [range 0.0-2.8]) than in normally ovulatory cycles (median 1.2 [range 0.0-2.3]) (P = 0.023). Cramp Scores did not differ by ovulatory status within the 19 women having both normally ovulatory and anovulatory cycles (P = 0.222). Within-woman 1-year Cramp Scores were not different in anovulatory and normally ovulatory menstrual cycles but were more intense with ovulatory disturbances.

Menstrual Problems and Lifestyle among Spanish University Women

Menstrual problems affect many young women worldwide, conditioning both their academic performance and quality of life. This study sought to analyse the prevalence of menstrual problems and their possible relationship with lifestyle among Spanish university women, as part of a research project (UniHcos Project) involving a cohort of 11 Spanish universities with 7208 university students. A descriptive analysis was performed using the bivariate chi-square test and the Student’s t-test together with a binary logistic regression, in which the dependent variable was ‘suffering from menstrual problems’. Menstrual problems were identified in 23.8% of the students, representing women who paid more visits to the doctor and to emergency rooms, and who consumed more painkillers and contraceptives. In relation to dietary preferences, menstrual problems were 1.39 (CI 95% 1.22–1.61; p = 0.000) times more likely among women classified as high-risk alcohol users according to the AUDIT questionnaire, and 1.187 (CI 95% 1.029–1.370; p = 0.019) times greater among those who consumed sweets daily, 1.592 (CI 95% 1.113–2.276; p = 0.011) times more frequent among those who eat fish daily, and 1.199 (CI 95% 1.004–1.432; p = 0.045) times greater among those who were dieting. Menstrual problems affect many college students and potentially modifiable lifestyle variables exist which may influence their prevalence. It would be interesting to develop programmes to promote women’s health in the university context.

Dysmenorrhea among high-school students and its associated factors in Kuwait

Background

Although dysmenorrhea is not a life-threatening condition, it can cause a substantial burden on individuals and communities. There is no data on the prevalence of dysmenorrhea in Kuwait. This study aimed to estimate the prevalence of dysmenorrhea among female public high-school students in Kuwait and investigate factors associated with dysmenorrhea.

Methods

A cross-sectional study using multistage cluster sampling with probability proportional to size method was conducted on 763 twelfth grade female public high-school students (aged 16–21 years). We used face-to-face interview with a structured questionnaire to collect data on dysmenorrhea and presumed risk factors. Weight and height of the students were measured using appropriate weight and height scales in a standardized manner. The association between dysmenorrhea and potential risk factors was assessed using multiple logistic regression.

Results

The one-year prevalence of dysmenorrhea was found to be 85.6% (95%CI: 83.1–88.1%). Of the participants with dysmenorrhea, 26% visited a public or a private clinic for their pain and 4.1% were hospitalized for their menstrual pain. Furthermore, 58.2% of students with dysmenorrhea missed at least one school day and 13.9% missed at least one exam. Age of menarche (p-value = 0.005), regularity and flow of the menstrual period (p-value = 0.025, p-value = 0.009; respectively), and drinking coffee (p-value = 0.004) were significantly associated with dysmenorrhea in multivariable analysis.

Conclusion

Dysmenorrhea seems to be highly prevalent among female high-school students in Kuwait, resembling that of high-income countries. Because of the scale of the problem, utilizing school nurses to reassure and manage students with primary dysmenorrhea and referring suspected cases of secondary dysmenorrhea is recommended.

Association of primary dysmenorrhea with anthropometrical and socio-economic factors in Polish university students

AIMS

To examine the prevalence and factors correlated with primary dysmenorrhea in young female subjects.

METHODS

Cross-sectional research was conducted among 1305 female university students aged 19-25 years. The following measurements were taken: height, body mass, waist circumference, hip circumference, the length of index and ring finger. A questionnaire was used to obtain information on menstrual pains, the characteristics of the menstrual cycles (regularity, duration), the number of the days of menstrual bleeding, age at menarche, overall health and socio-economic status of the subjects.

RESULTS

The prevalence of primary dysmenorrhea (PD) in the group was 64.85%, of which 69.60% reported mild pain, and 30.40% moderate and severe pain. PD occurs more frequently both in women with excess and insufficient level of abdominal adiposity. PD occurred more frequently in women who experience first menstruation at earlier age than in women with average and late age at menarche. The prevalence of PD grew along with mother's education and fell along with father's education. Painful menstruations occurred most commonly in women from large families. The impact of the age at menarche and the presence of abnormal body mass and abnormal level of abdominal adiposity on the prevalence of painful menstruation was also confirmed by the results of logistic regression analysis. The risk of PD is the highest in women whose finger 4 is longer than finger 2.

CONCLUSION

The results suggest that healthy body mass and lack of abdominal obesity may reduce the risk of PD.

Western dietary pattern is related to premenstrual syndrome: a case-control study

Although premenstrual syndrome (PMS) affects a large number of women of reproductive age, the aetiology of this disorder has not yet been fully elucidated. The relationship between food intake and PMS morbidity has been investigated in several studies, but dietary patterns of PMS patients have not been taken into consideration up to now. We examined dietary patterns of 320 nurses with (n 160) and without (n 160) PMS in a case-control study. Food intakes over the past year were determined using semi-quantitative FFQ. Factor analysis was used to identify the main dietary patterns, and logistic regression was used to model the relationship between dietary patterns and PMS morbidity. Three dietary patterns were identified in the analysis: healthy, Western and traditional. After adjustment for age, BMI, menstrual cycles, physical activity and energy intake, participants in the second (OR 2·53; 95 % CI 1·18, 5·43) and third (OR 4·39; 95 % CI 1·97, 9·81) quintiles of the Western dietary pattern were more likely to experience PMS compared with those in the first quintile. The study findings therefore reveal that Western dietary pattern might be associated with PMS morbidity. However, this result should be interpreted with caution as there was no evidence of a dose-response relationship. Future studies are needed to confirm our findings in other populations.

Factors related to dysmenorrhea among Vietnamese and Vietnamese marriage immigrant women in South Korea

OBJECTIVE

To find factors associated with dysmenorrhea, we surveyed the obstetric and gynecologic histories as well as socioeconomic factors of Vietnamese female residents in Can Tho (southern part of Vietnam) and Bavi (northern part of Vietnam) and Vietnamese female marriage immigrants living in South Korea.

METHODS

From March 2010 to March 2011, 3,017 Vietnamese women aged 17 to 42 years (mean, 25.5 years) were recruited. Socioeconomic factors as well as baseline characteristics, including gynecologic history and menstrual patterns, were collected using questionnaires. The relationships between these factors and dysmenorrhea were analyzed using chi-square test, independent t-test and logistic regression analysis.

RESULTS

Dysmenorrhea was found in 58.8% of all women. The mean age and the age at menarche were younger in the women with dysmenorrhea. A longer duration of menstrual flow and severe menstrual volume increased the risk of dysmenorrhea. The prevalence of dysmenorrhea was lower in women who had experienced pregnancy, term delivery and breastfeeding. The prevalence of dysmenorrhea in Vietnamese women was also different according to their educational status. When participants were divided according to their religious preferences, atheist women showed a lower prevalence with 55%, and women who were religious had a higher prevalence of dysmenorrhea. The body mass index, menstrual cycle length, monthly income, and duration of residency in Korea were not related with the prevalence of dysmenorrhea.

CONCLUSION

Socioeconomic factors as well as age, menstrual pattern and obstetric history were related with dysmenorrhea in Vietnamese women.

Endometriosis, dysmenorrhoea and diet

OBJECTIVE

To review the literature on the effects of diet on endometriosis and dysmenorrhoea.

STUDY DESIGN

A systematic search for trials investigating a relationship between diet and endometriosis/dysmenorrhoea was undertaken, and 23 studies were included in this review.

RESULTS

Data on the relationship between diet and endometriosis were limited to 12 trials, three of which were animal studies, resulting in a total of 74,708 women. One large study (n=70,709) found a relatively strong association between endometriosis and trans-fatty acid consumption, and a lower risk of endometriosis with increased consumption of long-chain omega-3 fatty acids. The latter finding was also supported by smaller studies. No further dietary recommendations for reducing the risk of endometriosis were possible, and results for intake of vegetable, fibre and fruit were equivocal. The relationship between diet and dysmenorrhoea was investigated in 11 trials with different designs, including a total of 1433 women. Intake of fish oil seemed to reduce dysmenorrhoea.

CONCLUSION

The literature on endometriosis and dysmenorrhoea in relation to diet is sparse, yielding equivocal results on specific elements. Overall, however, the literature suggests that specific types of dietary fats are associated with endometriosis and/or dysmenorrhoea, thereby indicating that there may be modifiable risk factors. Further research is recommended on both subjects.

Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students

The objective was to evaluate the prevalence of dysmenorrhea and determine its effect on health-related quality of life (HRQoL) among a group of female university students. This cross-sectional study was conducted between 15 March and 15 April 2009 at Dumlupinar University, Kutahya, Health High School, Western Turkey. The study group included 623 female students. The severity of dysmenorrhea was determined with a 10-point visual analog scale. The Short Form-36 (SF-36) form was used to determinate HRQoL. Chi-square test, Student's t test, and logistic regression and variance analyses (ANOVA) were used for statistical analyses. The average age of the study group was 20.8 +/- 1.8 years (range 17-30). Prevalence of dysmenorrhea was found to be 72.7% and was significantly higher in coffee consumers, females with menstrual bleeding duration > or =7 days, and those who had a positive family history of dysmenorrhea when compared to the others (P < 0.05, for each one). By multivariate analysis, coffee consumption (OR 2.084), menstrual bleeding duration > or =7 days (OR 1.590), and positive family history of dysmenorrhea (OR 3.043) were important risk factors for dysmenorrhea. Except for social functioning, role-emotional, and mental health domains, the SF-36 points received from the other domains were higher in females with dysmenorrhea (for each one P < 0.05). With the exception of the scores received from physical functioning and role-emotional domains, the scores received from the other domains of the SF-36 scale showed a decrease with increasing severity of dysmenorrhea (P < 0.05, for each one). Dysmenorrhea is a common health problem, having negative effects on the HRQoL among university female students.

Prevalence of menstrual pain in relation to the reproductive life history of women from the Mayan rural community

BACKGROUND

The prevalence of menstrual pain in Western societies is relatively high and has been shown to be related to many factors (e.g. age, menarche age, parity, menstrual cycle regularity, cigarette smoking, dietary habits). However, less data are available for traditional societies, within which there are, presumably, not as many potentially disturbing factors that could influence menstrual symptoms as in Western societies.

AIM

The study seeks to determine the prevalence of dysmenorrhoea, and the factors related to menstrual pains in women with natural fertility (i.e. without hormonal forms of contraception).

SUBJECTS AND METHODS

177 non-smoking women between 18 and 45 years of age living in one Mayan village (Yaxcaba, Yucatan, Mexico) were the subjects of this study. The method of logistic regression was used with the dichotomous dependent variable being the presence or absence of menstrual pain together with such independent variables as age, age at menarche, number of pregnancies, age when giving birth to the first child, the weight at interview and BMI.

RESULTS

The general prevalence of the menstrual pains was 28%. There was only one variable influencing dysmenorrhoea, namely the age at which women give birth to their first children. Those mothers who gave birth to their first child at an earlier age (at mean age of 19.4 vs 21.1 years) had a lower prevalence of dysmenorrhoea.

CONCLUSION

In the studied traditional society the main factor related to menstrual pain was the age at which woman first gave birth. It is hypothesized that an earlier start to reproductive life in some way decreases the sensitivity of the uterus to prostaglandins.

Endometriosis, dysmenorrhea and diet--what is the evidence?

The objective of this study is to assess the literature concerning the effect of diet on endometriosis and dysmenorrhea and to elucidate evidential support, to give dietary recommendations to women suffering from these conditions. A systematic search in electronic databases on a relationship between diet and endometriosis/dysmenorrhea was performed. Data on diet and endometriosis were limited to four trials of which two were animal studies. The articles concerning human consumption found some relation between disease and low intake of vegetable and fruit and high intake of vegetarian polyunsaturated fat, ham, beef and other red meat. Results concerning fish intake were not consistent. Eight trials of different design, with a total of 1097 women, investigated the relationship between diet and dysmenorrhea. Intake of fish oil seemed to have a positive effect on pain symptoms. This study concludes that literature on diet and endometriosis is sparse, whereas eight studies have looked at diet and dysmenorrhea. No clear recommendations on what diet to eat or refrain from to reduce the symptoms of endometriosis can be given, while a few studies indicate that fish oil can reduce dysmenorrhea. Further research is recommended on both subjects.

The burden and determinants of dysmenorrhoea: a population-based survey of 2262 women in Goa, India

OBJECTIVE

To describe the prevalence and determinants of dysmenorrhoea, the most common menstrual complaint, in a community in India.

DESIGN

Cross-sectional survey.

SETTING

Catchment area of primary health centre in Goa, India.

POPULATION

Three thousand women aged 18-45 years randomly selected. A total of 2494 women consented to participate (83.1%).

METHODS

Eligible participants were asked standardised questions regarding menstrual complaints over the past 12 months, and socio-demographic, psychosocial and reproductive risk factors. Vaginal or urine specimens were collected for the diagnosis of reproductive tract infections.

MAIN OUTCOME MEASURES

Dysmenorrhoea of moderate to severe intensity.

RESULTS

A total of 2262 women were eligible. More than half reported dysmenorrhoea; moderate to severe dysmenorrhoea was reported by 755 participants (33.4%, 95% CI 31.4-35.4). There was a linear association between severity of pain and impact (medication and taking rest) and the onset of pain (premenstrual onset associated with more severe pain). On multivariate analyses, the risk of moderate-severe dysmenorrhoea was associated with the experience of violence (OR 2.23, 95% CI 1.5-34); other somatic complaints (OR 3.67, 95% CI 2.7-4.9 for highest somatoform symptom score category compared with the lowest); gynaecological complaints (non-menstrual lower abdominal pain: OR 1.78, 95% CI 1.3-2.3; dysuria: OR 1.98, 1.4-2.7); menorrhagia (OR 1.92, 95% CI 1.4-2.6); and illiteracy (OR 1.32, 95% CI 1.0-1.7). Having had a pregnancy (OR 0.53, 95% CI 0.4-0.7), older age of menarche (OR 0.70, 95% CI 0.5-0.9, for age >14 compared with <13 years) and older age (OR 0.43, 0.3-0.6 for age 40-50, compared with 18-24 years) were protective.

CONCLUSIONS

The burden of dysmenorrhoea is greater than any other gynaecological complaint, and is associated with significant impact. Social disadvantage, co-morbidity with other somatic syndromes and reproductive factors are determinants of this complaint.

Prevalence of primary dysmenorrhea in Canada

OBJECTIVE

The aim of this study was to describe the prevalence, clinical effect, characteristics, and underlying risk factors of primary dysmenorrhea (PD) in Canada.

METHODS

A stratified, random sample of 2721 women 18 years and older was identified, and the women were interviewed by telephone. Data about menstrual symptoms and patterns and socio-demographic factors were obtained. The frequency, severity, and effect of menstrual pain were quantified. Logistic regression analysis was performed in order to identify independent risk factors for PD.

RESULTS

In the sample, 1546 women were having menstrual periods; of these, 934 (60%) met the criteria for PD. Sixty percent of the women with PD described their pain as moderate or severe. Fifty-one percent reported that their activities had been limited, and 17% reported missing school or work because of PD. The prevalence of PD decreased with increasing age (P < 0.001) and increased with smoking (P = 0.002). Users of oral contraceptives (OCs) tended to have less pain than non-users (P = 0.005). Socio-economic status, nulliparity, and earlier age at menarche were not independently associated with PD. However, nulliparous women, smokers, and women not using OCs were more likely to report disabling symptoms.

CONCLUSIONS

The majority of Canadian women will suffer from dysmenorrhea at some time during their reproductive years. Available prescription treatments are underused. Young age, smoking, and non-use of OCs are independent risk factors for PD.

Associations of menstrual pain with intakes of soy, fat and dietary fiber in Japanese women

OBJECTIVE

Intakes of soy, fat, and dietary fiber may be associated with the symptoms of dysmenorrhea through their biological effects on estrogens or prostaglandin production. The present study was to examine the relationships between intakes of soy, fat, and dietary fiber and the severity of menstrual pain.

DESIGN

Cross-sectional study.

SETTING

Three colleges and two nursing schools.

SUBJECTS

A total of 276 Japanese women aged 19-24 y.

METHODS

Intakes of nutrients and foods including soy products, isoflavones, fats and dietary fiber were estimated by a validated semiquantitative food frequency questionnaire. Severity of menstrual pain was assessed by the multidimensional scoring system reported by Andersch and Milson.

RESULTS

Intake of dietary fiber was significantly inversely correlated with the menstrual pain scale (r=-0.12, P=0.04) after controlling for age, smoking status, age at menarche and total energy intake. Neither soy nor fat intake was significantly correlated with menstrual pain after controlling for the covariates.

CONCLUSIONS

The cross-sectional difference in dietary fiber intake across the level of menstrual pain was small in magnitude but warrants further studies.

Metabolic gene polymorphisms and risk of dysmenorrhea

We conducted a molecular epidemiologic study in rural China to investigate the association of the cytochrome P450 2D6 (CYP2D6) and glutathione S-transferase Mu (GSTM1) polymorphisms with dysmenorrhea. This report includes 435 subjects, 129 with and 306 without any history of dysmenorrhea, who did not smoke or drink alcohol. We obtained information on dysmenorrhea and major covariates by questionnaire interview. We used categorical methods and logistic regression models to evaluate the individual and combined associations of CYP2D6 and GSTM1 polymorphisms with dysmenorrhea and its subgroups, occasional (N = 70) and recurrent (N = 59), with adjustment for age, education, occupation, passive smoke exposure, age of menarche, parity, contraceptive method, height, and body mass index. Both variant CYP2D6 and GSTM1 genotypes were associated with increased risk of recurrent dysmenorrhea [for CYP2D6, odds ratio (OR) = 1.7 and 95% confidence interval (95% CI) = 0.9-3.1; for GSTM1, OR = 1.8 and 95% CI = 1.0-3.4). There was no appreciable association between these variant genotypes and occasional dysmenorrhea. When both the CYP2D6 and GSTM1 genotypes were considered together, the highest risk of recurrent dysmenorrhea was found among women with variant genotypes in both CYP2D6 and GSTM1 (OR = 3.1; 95% CI = 1.2-8.0). This study provides evidence of genetic susceptibility to recurrent dysmenorrhea.