Primary Dysmenorrhea Associated with Psychological Distress in Medical Sciences Students in The North of Iran: A Cross-Sectional Study

Document Type : Original Article


1 Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

2 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

3 Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran

4 Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran


Background: Primary dysmenorrhea is the usual medical status in medical students that are defined as pain
during the menstrual period. This study was done to evaluate the psychological problems associated with dysmenorrhea.
Materials and Methods: Three hundred forty students aged 18 to 20 years participated in this cross‑sectional
study (194 with dysmenorrhea and 150 without dysmenorrhea). In this cross‑sectional study, data were collected
through the sociodemographic checklist, the verbal multidimensional scoring system (VMS), and the revised
version of the Symptom Checklist-90 (SCL-90-R) questionnaire using the convenience sampling method. This
questionnaire includes 9 Subscale and a GSI index. We considered psychological distress to be equivalent to
the Global Severity İndex (GSI), which is obtained by dividing 90 questions by 90. The significance level of the
tests was considered 0.05.
Results: The GSI of the SCL-90 score in the 194 students with dysmenorrhea and 150 students without dysmenorrhea
was 1.02 ± 0.42 and 0.34 ± 0.15 respectively (P<0.001). In the group with dysmenorrhea, the severity
of dysmenorrhea was significantly associated with a family history of dysmenorrhea and mother's education
(P=0.012 and P=0.037, respectively). The strongest predictors of GSI>1 were a family history of dysmenorrhea
and mother’s education [odds ratio (OR)=2.33, 95% confidence interval (CI), 1.43-4.15 and OR=0.45, 95% CI,
0.24-0.87, respectively].
Conclusion: According to the result, dysmenorrhea is associated with psychological distress. Psychological interventions
and counseling in addition to drug treatment are suggested for treatment of primary dysmenorrhea.
Therefore, it is necessary to formulate strategies and health policies to recover psychological issues of menstrual


  1. Vlachou E, Owens DA, Lavdaniti M, Kalemikerakis J, Evagelou E, Margari N, et al. Prevalence, wellbeing, and symptoms of dysmenorrhea among university nursing students in Greece. Diseases. 2019; 7(1): 5.
  2. Ameade EPK, Amalba A, Mohammed BS. Prevalence of dysmenorrhea among University students in Northern Ghana; its impact and management strategies. BMC Womens Health. 2018; 18(1): 39.
  3. Tsamara G, Raharjo W, Putri EA. The relationship between life style with the incidence of primary dysmenorrhea in medical faculty female students of tanjungpura university. J Nas Ilmu Kesehat. 2020; 2(3): 130-140.
  4. Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Res. 2017; 6: 1645.
  5. Salmalian H, Saghebi R, Moghadamnia AA, Bijani A, Faramarzi M, Amiri FN, et al. Comparative effect of thymus vulgaris and ibuprofen on primary dysmenorrhea: a triple-blind clinical study. Caspian J Intern Med. 2014; 5(2): 82.
  6. Adib-Rad H, Basirat Z, Bakouei F, Moghadamnia AA, Khafri S, Kotenaei ZF, et al. Effect of ginger and novafen on menstrual pain: A cross-over trial. Taiwan J Obstet Gynecol. 2018; 57(6): 806-809.
  7. Faramarzi M, Salmalian H. Association of psychologic and nonpsychologic factors with primary dysmenorrhea. Iran Red Crescent Med J. 2014; 16(8): e16307.
  8. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015; 21(6): 762-778.
  9. Gebeyehu MB, Mekuria AB, Tefera YG, Andarge DA, Debay YB, Bejiga GS, et al. Prevalence, impact, and management practice of dysmenorrhea among University of Gondar Students, Northwestern Ethiopia: a cross-sectional study. Int J Reprod Med. 2017; 2017: 1-8.
  10. Ambresin A-E, Belanger RE, Chamay C, Berchtold A, Narring F. Body dissatisfaction on top of depressive mood among adolescents with severe dysmenorrhea. J Pediatr Adolesc Gynecol. 2012; 25(1): 19-22.
  11. Pakpour AH, Kazemi F, Alimoradi Z, Griffiths MD. Depression, anxiety, stress, and dysmenorrhea: a protocol for a systematic review. Syst Rev. 2020; 9(1): 1-6.
  12. Jha N, Bhadoria AS, Bahurupi Y, Gawande K, Jain B, Chaturvedi J, et al. Psychosocial and stress-related risk factors for abnormal menstrual cycle pattern among adolescent girls: a case-control study. J Educ Health Promot. 2020; 9: 313.
  13. Ortiz MI. Primary dysmenorrhea among Mexican university students: prevalence, impact and treatment. Eur J Obstet Gynecol Reprod Biol. 2010; 152(1): 73-77.
  14. Unsal A, Ayranci U, Tozun M, Arslan G, Calik E. Prevalence of dysmenorrhea and its effect on quality of life among a group of

female university students. Ups J Med Sci. 2010; 115(2): 138-145.

  1. Firozi MZT. Primary dysmenorrhea and herbal medicine. J Med Plants. 2016; 15(60): 58-65.
  2. Derogatis LR, Unger R. Symptom checklist-90-revised. Corsini encyclopedia of psychology. 2010: 1-2.
  3. Anisi J, Akbari F, Madjian M, Atashkar M, Ghobani Z. Standardization of mental disorders symptoms checklist 90 revised (SCL-90-R) in army staffs. Journal of Military Psychology (JMP) . 2011; 2(5): 29-37.
  4. Wang C, Liu Y, Dun W, Zhang T, Yang J, Wang K, et al. Effects of repeated menstrual pain on empathic neural responses in women with primary dysmenorrhea across the menstrual cycle. Hum Brain Mapp. 2021; 42(2): 345-356.
  5. Fukushima K, Fukushima N, Sato H, Yokota J, Uchida K. Association between nutritional level, menstrual-related symptoms, and mental health in female medical students. PLoS One. 2020; 15(7): e0235909.
  6. Bhusal CK, Bhattarai S, Kafle R, Shrestha R, Chhetri P, Adhikari K. Level and associated factors of knowledge regarding menstrual hygiene among school-going adolescent girls in Dang district,Nepal. Adv Prev Med. 2020; 2020: 8872119.
  7. Al-Matouq S, Al-Mutairi H, Al-Mutairi O, Abdulaziz F, Al-Basri D, Al- Enzi M, et al. Dysmenorrhea among high-school students and its associated factors in Kuwait. BMC Pediatr. 2019; 19(1): 1-12.
  8. Momma R, Nakata Y, Sawai A, Takeda M, Natsui H, Mukai N, et al. Comparisons of the prevalence, severity, and risk factors of dysmenorrhea between Japanese female athletes and non-athletes in universities. Int J Environ Res Public Health. 2022; 19(1): 52.
  9. Azagew AW, Kassie DG, Walle TA. Prevalence of primary dysmenorrhea, its intensity, impact and associated factors among female students’ at Gondar town preparatory school, northwest Ethiopia. BMC Womens Health. 2020; 20(1): 5.
  10. Ibrahim NK, AlGhamdi MS, Al-Shaibani AN, AlAmri FA, Alharbi HA, Al-Jadani AK, et al. Dysmenorrhea among female medical students in King Abdulaziz university: prevalence, predictors and outcome. Pak J Med Sci. 2015; 31(6): 1312-1317.
  11. Anikwe CC, Mamah JE, Okorochukwu BC, Nnadozie UU, Obarezi CH, Ekwedigwe KC. Age at menarche, menstrual characteristics, and its associated morbidities among secondary school students in Abakaliki, southeast Nigeria. Heliyon. 2020; 6(5): e04018.
  12. Tadese M, Kassa A, Muluneh AA, Altaye G. Prevalence of dysmenorrhoea, associated risk factors and its relationship with academic performance among graduating female university students in Ethiopia: a cross-sectional study. BMJ Open. 2021; 11(3): e043814.
  13. Dias SFL, Pereira LCA, Oliveira APd, Santos RFd, Nunes LCC. Scientific and technological prospection on transdermal formulations and complementary therapies for the treatment of primary dysmenorrhea. Expert Opin Ther Pat. 2019; 29(2): 115-126.
  14. Çelik AS, Apay SE. Effect of progressive relaxation exercises on primary dysmenorrhea in Turkish students: A randomized prospective controlled trial. Complement Ther Clin Pract. 2021; 42: 101280.
  15. Aaron RV, Fisher EA, Palermo TM. Alexithymia in adolescents with and without chronic pain. Rehabil Psychol. 2019; 64(4): 469-474.
  16. Rafique N, Al-Sheikh MH. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Med J. 2018; 39(1): 67-73.
  17. Ansong E, Arhin SK, Cai Y, Xu X, Wu X. Menstrual characteristics, disorders and associated risk factors among female international students in Zhejiang Province, China: a cross-sectional survey. BMC womens health. 2019; 19(1): 1-10.
  18. Dehkordi ZR. 53: Evaluate the effect of perceived stress on dysmenorrhea. BMJ Open. 2017; 7 Suppl 1: bmjopen-2016-015415.53.
  19. Zeru AB, Gebeyaw ED, Ayele ET. Magnitude and associated factors of menstrual irregularity among undergraduate students of Debre Berhan University, Ethiopia. Reprod Health. 2021; 18: 101.
  20. Natt AM, Khalid F, Sial SS. Relationship between examination stress and menstrual irregularities among medical students of rawalpindi medical university. JRMC. 2018; 22(S-1): 44-47.
  21. Nagma S, Kapoor G, Bharti R, Batra A, Batra A, Aggarwal A, et al. To evaluate the effect of perceived stress on menstrual function. J Clin Diagn Res. 2015; 9(3): QC01-QC03.
  22. Parra-Fernández ML, Onieva-Zafra MD, Abreu-Sánchez A, Ramos-Pichardo JD, Iglesias-López MT, Fernández-Martínez E. Management of primary dysmenorrhea among university students in the South of Spain and family influence. Int J Environ Res Public Health. 2020; 17(15): 5570.