The Epidemiology of Menstrual Pain in a South African University Population

Abstract

Dysmenorrhoea, pain associated with menstruation, is a significant public health concern among young women of reproductive age. Identifying associated risk factors for the development of dysmenorrhoea is essential to minimize the impact of monthly menstrual pain on the daily functioning of these women, both in a personal and professional capacity. However, epidemiological data on the prevalence and associated risk factors for dysmenorrhoea in South Africa are scarce. This study aimed to determine the prevalence of dysmenorrhoea and its associated risk factors in a South African university student and staff population. An online survey was distributed to all 26 public universities across South Africa. The final sample comprised data from 7280 participants, and I found a high prevalence [76.7% (95% CI, 75.7-77.6)] of moderate-to-severe dysmenorrhoea among the respondents. Factors significantly associated with increase odds of experiencing moderate to severe dysmenorrhoea included: having heavy (adjusted OR = 2.749, 95% CI 2.208-3.421; p < 0.001) menstrual flow, having a positive family history of dysmenorrhoea (adjusted OR = 1.615, 95% CI 1.346-1.938; p < 0.001), always experiencing poorer subjective sleep quality [“often” (OR= 1.595, 95% CI 1.16-2.191; p=0.004), “sometimes” (OR= 1.523, 95% CI 1.22-1.902; p=0.0002) and “rarely” (OR=2.046, 95% CI 1.596-2.623; p<0.0001)], and scoring higher on the central sensitisation inventory total score (adjusted OR= 1.033, 95% CI 1.026-1.04; p < 0.001). On the other hand, factors significantly associated with decrease odds of experiencing moderate to severe dysmenorrhoea included: older age at the time of the study (adjusted OR= 0.982, 95% CI 0.967-0.998; p= 0.0285), older age at menarche (adjusted OR = 0.938, 95% CI 0.89-0.989; p= 0.0186), having been pregnant (adjusted OR = 0.757, 95% CI 0.605-0.946; p= 0.0145), lower BMI (adjusted OR = 0.986, 95% CI 0.972-1; p = 0.044), being of European ancestry (adjusted OR = 0.698, 95% CI 0.567-0.859; p = 0.007), and having light menstrual flow (adjusted OR= 0.473, 95% CI 0.373-0.6; p < 0.001). I also found a significant impact of dysmenorrhoea on daily life, with 51.6% of respondents reporting absenteeism from school or work during menses and 88.4% of the respondents requiring pharmacological treatments, such as contraceptive pills and nonsteroidal anti-inflammatory drugs (NSAIDs), to manage their menstrual pain. The study highlights the need for increased awareness, education, and effective interventions aimed at reducing the prevalence and impact of dysmenorrhoea on women's lives. The implications of both the increased central sensitisation (CS) and the sleep-pain reciprocal relationship suggest that they could potentially lead to the development of chronic pain conditions. Future research should further explore the interventions and management strategies that could improve sleep quality and prevent the onset of central sensitisation, thus reducing the risk of developing chronic pain conditions. The findings have important implications for the management of dysmenorrhoea that can improve women's quality of life and promote better health outcomes. These findings also point towards the need to educate women about the importance of seeking medical attention for dysmenorrhoea and the potential long-term implications of untreated dysmenorrhoea