OBJECTIVES: The factors that underlie pelvic pain are poorly understood.
Specifically, the relative influence of dysmenorrhea and psychological factors in the etiology of non-cyclic 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 non-cyclic pelvic pain symptoms.
METHODS: 1,012 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 non-cyclic 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 non-cyclic pelvic pain (54/402, 13%) than women without dysmenorrhea (5/432, 1%; OR=13, 95% CI=5-33). In a multivariate-adjusted model, dysmenorrhea (β=.17), activity capability (β=.17), somatic complaint (β=.17), and bodily pain (β=.12) and were the primary predictors of non-cyclic 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 non-cyclic pelvic pain.
CONCLUSION: The association between dysmenorrhea and non-cyclic pelvic pain, suggests that menstrual pain is an etiological factor in non-cyclic pelvic pain, whereas depression and anxiety may be secondary effects. Longitudinal studies are needed to determine whether dysmenorrhea causally influences development of non-cyclic pelvic pain or shares common underlying neural mechanisms.
Westling MA, Tu F, Griffith JW, Hellman KM. Are you the author?
Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL.
Reference: Am J Obstet Gynecol. 2013 Aug 22. pii: S0002-9378(13)00860-0.