Who’s at risk for painful periods?

Pain is often considered a fact of life for people with menstrual cycles.

Yet, for an experience that is so common in women and girls, the risk factors for painful periods have not been closely studied.

A recent study from Melissa Lenert, Ph.D., and her colleagues at University of Michigan look more closely at dysmenorrhea (the clinical term for pain that comes with menstruation) in girls before and after their first periods.

The research is borne of Lenert’s interest in the clinical aspects of pain and collaborative research between U-M’s Chronic Pain and Fatigue Research Center and U-M’s Chronic Pelvic Pain Consultative Clinic.

“A lot of patients have been saying anecdotally that much of their chronic pelvic pain started when they were kids,” said Lenert.

To investigate this, her team used the analyzed survey responses of more than 2000 female adolescents and their guardians from the population-based Adolescent Brain Cognitive Development Study (USA), focusing on girls who hadn’t yet had their period at age 9-10 and then had started their periods three years later.

Parent surveys included the Child Behavior Checklist, the Sleep Disturbance Scale for Children, and the Pubertal Development Scale, which captured data on non-painful physical symptoms, attention problems, anxiety, depression, sleep disturbances, and pubertal development at baseline.

The team found that of the girls who had started their periods at the three-year follow up point, a little over 57% reported painful periods, with 19% reporting severe pain.

Those with more physical puberty symptoms were more likely to report painful periods.

Surprisingly, notes Lenert, anxiety and depression and attention problems at age 9 and 10 weren't associated with future period pain.

And while sleep disturbances were not predictive of having period pain, they were associated with the amount that pain interfered with daily life.

“I think these findings are important because they give us insight into things we can do to help,” said Lenert.

“Sleep hygiene is something we can target to perhaps manage pain. It’s also important to note that anxiety and depression don’t come first in the case of pelvic pain,” she said.

“If we treat the pain effectively, maybe we can help with those symptoms later down the line, too.”

The team also looked at participant demographics to see whether other characteristics corresponded with the experience of painful periods.

They found that Black and Hispanic girls were more likely to report severe period pain than White and non-Hispanic girls, a finding Lenert hopes to dig into more closely in future research.

“I want to understand is in these girls that we've identified very early, what's their trajectory look like as they're getting older? Are they reporting more multi-site or chronic pain conditions? And how does this severe dysmenorrhea impact their development?”

As for what parents and caregivers can do to help, Lenert says start by listening and believing.

“Believe our girls. Don't dismiss menstrual pain by saying ‘well, everybody has it’,” said Lenert.

“I think too many of people are in a situation where they’re told that for 10 years only to end up at our endometriosis and chronic pelvic pain clinic and suddenly, they're undergoing surgery or hysterectomy. I think we can try to intervene before that happens.”

Additional authors: Tristin Smith, Esmeralda Hidalgo-Lopez, Christel M Portengen, Steven E Harte, Adriene M Beltz, Andrew Schrepf, Chelsea M Kaplan

Paper cited: “Premenarche risk factors for future dysmenorrhoea: a prospective cohort study”. Lancet Child and Adolescent Health, DOI: 10.1016/S2352-4642(26)00165-3 

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