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. 2004 Dec;61(12):1021–1026. doi: 10.1136/oem.2003.012302

Stress and dysmenorrhoea: a population based prospective study

L Wang 1, X Wang 1, W Wang 1, C Chen 1, A Ronnennberg 1, W Guang 1, A Huang 1, Z Fang 1, T Zang 1, L Wang 1, X Xu 1
PMCID: PMC1740691  PMID: 15550609

Abstract

Background: Dysmenorrhoea is the most common gynaecological disorder in women of reproductive age. Despite the association between stress and pregnancy outcomes, few studies have examined the possible link between stress and dysmenorrhoea.

Aims and Methods: Using a population based cohort of Chinese women, the independent effect of women's perceived stress in the preceding menstrual cycle on the incidence of dysmenorrhoea in the subsequent cycle was investigated prospectively. The analysis included 1160 prospectively observed menstrual cycles from 388 healthy, nulliparous, newly married women who intended to conceive. The perception of stress and the occurrence of dysmenorrhoea in each menstrual cycle were determined from daily diaries recorded by the women.

Results: After adjustment for important covariates, the risk of dysmenorrhoea was more than twice as great among women with high stress compared to those with low stress in the preceding cycle (OR = 2.4; 95% CI 1.4 to 4.3). The risk of dysmenorrhoea was greatest among women with both high stress and a history of dysmenorrhoea compared to women with low stress and no history of dysmenorrhoea (OR = 10.4, 95% CI 4.9 to 22.3). Stress in the follicular phase of the preceding cycles had a stronger association with dysmenorrhoea than stress in the luteal phase of the preceding cycles.

Conclusion: This study shows a significant association between stress and the incidence of dysmenorrhoea, which is even stronger among women with a history of dysmenorrhoea.

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Selected References

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  1. Andersch B., Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol. 1982 Nov 15;144(6):655–660. doi: 10.1016/0002-9378(82)90433-1. [DOI] [PubMed] [Google Scholar]
  2. Austin M. P., Leader L. Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms. Aust N Z J Obstet Gynaecol. 2000 Aug;40(3):331–337. doi: 10.1111/j.1479-828x.2000.tb03344.x. [DOI] [PubMed] [Google Scholar]
  3. Casey M. L., MacDonald P. C., Mitchell M. D. Despite a massive increase in cortisol secretion in women during parturition, there is an equally massive increase in prostaglandin synthesis. A paradox? J Clin Invest. 1985 Jun;75(6):1852–1857. doi: 10.1172/JCI111899. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chatterton R. T. The role of stress in female reproduction: animal and human considerations. Int J Fertil. 1990 Jan-Feb;35(1):8–13. [PubMed] [Google Scholar]
  5. Chen C., Cho S. I., Damokosh A. I., Chen D., Li G., Wang X., Xu X. Prospective study of exposure to environmental tobacco smoke and dysmenorrhea. Environ Health Perspect. 2000 Nov;108(11):1019–1022. doi: 10.1289/ehp.001081019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Christiani DC, Niu T, Xu X. Occupational Stress and Dysmenorrhea in Women Working in Cotton Textile Mills. Int J Occup Environ Health. 1995 Jan;1(1):9–15. doi: 10.1179/oeh.1995.1.1.9. [DOI] [PubMed] [Google Scholar]
  7. Clarvit S. R. Stress and menstrual dysfunction in medical students. Psychosomatics. 1988 Fall;29(4):404–409. doi: 10.1016/S0033-3182(88)72341-5. [DOI] [PubMed] [Google Scholar]
  8. Copper R. L., Goldenberg R. L., Das A., Elder N., Swain M., Norman G., Ramsey R., Cotroneo P., Collins B. A., Johnson F. The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks' gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 1996 Nov;175(5):1286–1292. doi: 10.1016/s0002-9378(96)70042-x. [DOI] [PubMed] [Google Scholar]
  9. Dawood M. Y. Dysmenorrhea. J Reprod Med. 1985 Mar;30(3):154–167. [PubMed] [Google Scholar]
  10. Dole N., Savitz D. A., Hertz-Picciotto I., Siega-Riz A. M., McMahon M. J., Buekens P. Maternal stress and preterm birth. Am J Epidemiol. 2003 Jan 1;157(1):14–24. doi: 10.1093/aje/kwf176. [DOI] [PubMed] [Google Scholar]
  11. Ericson A., Källén B. A. Nonsteroidal anti-inflammatory drugs in early pregnancy. Reprod Toxicol. 2001 Jul-Aug;15(4):371–375. doi: 10.1016/s0890-6238(01)00137-x. [DOI] [PubMed] [Google Scholar]
  12. Friederich M. A. Dysmenorrhea. Women Health. 1983 Summer-Fall;8(2-3):91–106. doi: 10.1300/J013v08n02_05. [DOI] [PubMed] [Google Scholar]
  13. Gordley L. B., Lemasters G., Simpson S. R., Yiin J. H. Menstrual disorders and occupational, stress, and racial factors among military personnel. J Occup Environ Med. 2000 Sep;42(9):871–881. doi: 10.1097/00043764-200009000-00005. [DOI] [PubMed] [Google Scholar]
  14. Harlow S. D., Park M. A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol. 1996 Nov;103(11):1134–1142. doi: 10.1111/j.1471-0528.1996.tb09597.x. [DOI] [PubMed] [Google Scholar]
  15. Hayes Ellen C., Rock John A. COX-2 inhibitors and their role in gynecology. Obstet Gynecol Surv. 2002 Nov;57(11):768–780. doi: 10.1097/00006254-200211000-00023. [DOI] [PubMed] [Google Scholar]
  16. Hedegaard M., Henriksen T. B., Secher N. J., Hatch M. C., Sabroe S. Do stressful life events affect duration of gestation and risk of preterm delivery? Epidemiology. 1996 Jul;7(4):339–345. doi: 10.1097/00001648-199607000-00001. [DOI] [PubMed] [Google Scholar]
  17. Hogan M. D., Kupper L. L., Most B. M., Haseman J. K. Alternatives to Rothman's approach for assessing synergism (or antagonism) in cohort studies. Am J Epidemiol. 1978 Jul;108(1):60–67. [PubMed] [Google Scholar]
  18. Hornsby P. P., Wilcox A. J., Weinberg C. R. Cigarette smoking and disturbance of menstrual function. Epidemiology. 1998 Mar;9(2):193–198. [PubMed] [Google Scholar]
  19. Jamieson D. J., Steege J. F. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996 Jan;87(1):55–58. doi: 10.1016/0029-7844(95)00360-6. [DOI] [PubMed] [Google Scholar]
  20. Kaunitz A. M. Reappearance of the intrauterine device: a 'user-friendly' contraceptive. Int J Fertil Womens Med. 1997 Mar-Apr;42(2):120–127. [PubMed] [Google Scholar]
  21. Levi L., Bartley M., Marmot M., Karasek R., Theorell T., Siegrist J., Peter R., Belkić K., Savić C., Schnall P. Stressors at the workplace: theoretical models. Occup Med. 2000 Jan-Mar;15(1):69–106. [PubMed] [Google Scholar]
  22. Lobel M., Dunkel-Schetter C., Scrimshaw S. C. Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women. Health Psychol. 1992;11(1):32–40. doi: 10.1037//0278-6133.11.1.32. [DOI] [PubMed] [Google Scholar]
  23. Lundström V., Gréen K. Endogenous levels of prostaglandin F2alpha and its main metabolites in plasma and endometrium of normal and dysmenorrheic women. Am J Obstet Gynecol. 1978 Mar 15;130(6):640–646. doi: 10.1016/0002-9378(78)90320-4. [DOI] [PubMed] [Google Scholar]
  24. Morimoto K., Oku M. [Effect of progesterone, cortisol and dehydroepiandrosterone-sulfate on prostaglandin production by cultured human myometrial cells]. Nihon Sanka Fujinka Gakkai Zasshi. 1995 Apr;47(4):391–397. [PubMed] [Google Scholar]
  25. Nordentoft M., Lou H. C., Hansen D., Nim J., Pryds O., Rubin P., Hemmingsen R. Intrauterine growth retardation and premature delivery: the influence of maternal smoking and psychosocial factors. Am J Public Health. 1996 Mar;86(3):347–354. doi: 10.2105/ajph.86.3.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rees M. C., Anderson A. B., Demers L. M., Turnbull A. C. Prostaglandins in menstrual fluid in menorrhagia and dysmenorrhoea. Br J Obstet Gynaecol. 1984 Jul;91(7):673–680. doi: 10.1111/j.1471-0528.1984.tb04829.x. [DOI] [PubMed] [Google Scholar]
  27. Rini C. K., Dunkel-Schetter C., Wadhwa P. D., Sandman C. A. Psychological adaptation and birth outcomes: the role of personal resources, stress, and sociocultural context in pregnancy. Health Psychol. 1999 Jul;18(4):333–345. doi: 10.1037//0278-6133.18.4.333. [DOI] [PubMed] [Google Scholar]
  28. Sundell G., Milsom I., Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol. 1990 Jul;97(7):588–594. doi: 10.1111/j.1471-0528.1990.tb02545.x. [DOI] [PubMed] [Google Scholar]
  29. Svanberg L., Ulmsten U. The incidence of primary dysmenorrhea in teenagers. Arch Gynecol. 1981;230(3):173–177. doi: 10.1007/BF02111800. [DOI] [PubMed] [Google Scholar]
  30. Vale W., Spiess J., Rivier C., Rivier J. Characterization of a 41-residue ovine hypothalamic peptide that stimulates secretion of corticotropin and beta-endorphin. Science. 1981 Sep 18;213(4514):1394–1397. doi: 10.1126/science.6267699. [DOI] [PubMed] [Google Scholar]
  31. Wadhwa P. D., Dunkel-Schetter C., Chicz-DeMet A., Porto M., Sandman C. A. Prenatal psychosocial factors and the neuroendocrine axis in human pregnancy. Psychosom Med. 1996 Sep-Oct;58(5):432–446. doi: 10.1097/00006842-199609000-00006. [DOI] [PubMed] [Google Scholar]
  32. Wang Xiaobin, Chen Changzhong, Wang Lihua, Chen Dafang, Guang Wenwei, French Jonathan. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril. 2003 Mar;79(3):577–584. doi: 10.1016/s0015-0282(02)04694-0. [DOI] [PubMed] [Google Scholar]
  33. Willman E. A., Collins W. P., Clayton S. G. Studies in the involvement of prostaglandins in uterine symptomatology and pathology. Br J Obstet Gynaecol. 1976 May;83(5):337–341. doi: 10.1111/j.1471-0528.1976.tb00839.x. [DOI] [PubMed] [Google Scholar]
  34. Ylikorkala O., Dawood M. Y. New concepts in dysmenorrhea. Am J Obstet Gynecol. 1978 Apr 1;130(7):833–847. doi: 10.1016/0002-9378(78)90019-4. [DOI] [PubMed] [Google Scholar]

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