Dysmenorrhea Catastrophizing Contributes to Pain Interference in Chronic Pelvic Pain

Dysmenorrhea catastrophizing was found to be associated with dysmenorrhea and pain interference among women with chronic pelvic pain, according to the results of a study published in Frontiers in Pain Research. According to the study authors, “Dysmenorrhea, or painful menstrual cramps, is the most common gynecological condition during women’s reproductive years and can be associated with substantial interference with daily life.”

Women (N=104) who received treatment for chronic pelvic pain at a tertiary gynecologic clinic associated with the University of Rochester Medical Center in New York between 2017 and 2020 were recruited for this cross-sectional study. Patients responded to a questionnaire about dysmenorrhea catastrophizing, dysmenorrhea interference, and pain interference that used scores derived from the Pain Catastrophizing Scale (PCS) and the Brief Pain Inventory-Pain Interference (BPI-PI) instrument.

The mean age of study participants was 35.8±13.6 years at the time of the clinic visit, 80.8% were White, mean body mass index (BMI) was 28.0±8.4 kg/m² at the initial visit, and mean pain intensity on a 0- to 4-point Likert scale was 2.3±0.9 points. The most frequently reported diagnoses included myofascial pelvic pain (60.6%), major depressive disorder (56.7%), generalized anxiety disorder (44.2%), and irritable bowel syndrome (43.4%).

More than one-half of study participants reported experiencing the onset of dysmenorrhea with the first or second period, and nearly three-quarters of study participants reported experiencing dysmenorrhea during every period. The intensity of dysmenorrhea without medication was reported as severe by approximately one-half of the study participants.

The mean dysmenorrhea catastrophizing score was 2.53 points, and the mean interference score was 2.35 points (range for both, 1-4). Both scores correlated significantly with each other and with dysmenorrhea frequency, duration, intensity, PCS score, BPI-PI score, and the number of management strategies used (all P <.05).

Predictors for dysmenorrhea interference included dysmenorrhea catastrophizing (β, 0.44; P <.001), dysmenorrhea intensity (β, 0.29; P =.009), and age at clinic visit (β, 0.01; P =.021). Chronic pelvic pain interference was predicted by pelvic pain intensity (β, 0.96; P =.006) and dysmenorrhea catastrophizing (β, 0.63; P =.032).

In the exploratory analysis, women reporting dysmenorrhea intensity as “the worst pain imaginable” (β, 1.62) or as severe (β, 1.28) were found to be more likely to report higher dysmenorrhea catastrophizing compared with those reporting dysmenorrhea as being of mild intensity (P <.001).

The findings of this study may have been biased by the fact that the severity of chronic pelvic pain and dysmenorrhea at the time of the clinic visit may have affected patient recall and responses.

These data indicate that dysmenorrhea catastrophizing increased dysmenorrhea and pain interference among women with chronic pelvic pain, and that increased dysmenorrhea intensity was associated with increased dysmenorrhea catastrophizing.