title: The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors.
abstract: OBJECTIVE
  The factors that underlie pelvic pain are poorly understood. Specifically, the relative influence of dysmenorrhea and psychological factors in the etiology of noncyclic 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 noncyclic pelvic pain symptoms.
  
  
  METHODS
  A total of 1012 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 noncyclic 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 noncyclic pelvic pain (54/402, 13%) than women without dysmenorrhea (5/432, 1%; odds ratio, 13; 95% confidence interval, 5-33). In a multivariate-adjusted model, dysmenorrhea (β = .17), activity capability (β = .17), somatic complaint (β = .17), and bodily pain (β = .12) were the primary predictors of noncyclic 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 noncyclic pelvic pain.
  
  
  CONCLUSIONS
  The association between dysmenorrhea and noncyclic pelvic pain suggests that menstrual pain is an etiological factor in noncyclic pelvic pain, whereas depression and anxiety may be secondary effects. Longitudinal studies are needed to determine whether dysmenorrhea causally influences development of noncyclic pelvic pain or shares common underlying neural mechanisms.
authors: Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL.
authors: Allyson M
authors: AM
authors: Westling
authors: Frank F
authors: FF
authors: Tu
authors: James W
authors: JW
authors: Griffith
authors: Kevin M
authors: KM
authors: Hellman
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D018856:Cystitis, Interstitial / Q000453:epidemiology / Q000523:psychology*; D004412:Dysmenorrhea / Q000453:epidemiology / Q000523:psychology*; D004414:Dyspareunia / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000523:psychology*; D017699:Pelvic Pain / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: dysmenorrhea; interstitial cystitis; irritable bowel syndrome; pelvic pain
references: Pain. 2011 Sep;152(9):1966-1975
references: 21524851
references: Ceska Gynekol. 2002 Jan;67(1):38-46
references: 11881281
references: J Pers Soc Psychol. 1989 Feb;56(2):267-83
references: 2926629
references: Behav Genet. 1998 Mar;28(2):107-16
references: 9583236
references: J Reprod Med. 1991 Apr;36(4):253-9
references: 1830102
references: BMJ. 2006 Apr 1;332(7544):749-55
references: 16484239
references: Gen Hosp Psychiatry. 2008 May-Jun;30(3):191-9
references: 18433651
references: Arch Gynecol. 1981;230(3):173-7
references: 7247462
references: Control Clin Trials. 2003 Aug;24(4):390-410
references: 12865034
references: Pain. 2010 Nov;151(2):307-322
references: 20638177
references: Aust N Z J Public Health. 2004 Aug;28(4):369-75
references: 15704703
references: J Urol. 2012 Jun;187(6):2106-12
references: 22503014
references: BMC Gastroenterol. 2010 Aug 05;10:88
references: 20687933
references: Eur J Pain. 2006 May;10(4):287-333
references: 16095934
references: Am J Obstet Gynecol. 2002 Jun;186(6):1268-71; discussion 1271-3
references: 12066108
references: Br J Obstet Gynaecol. 1989 Oct;96(10):1153-62
references: 2531611
references: JAMA. 2004 Mar 24;291(12):1464-70
references: 15039413
references: Br J Gen Pract. 2001 Jul;51(468):541-7
references: 11462313
references: J Reprod Med. 1999 May;44(5):411-6
references: 10360252
references: Arch Womens Ment Health. 2006 Jan;9(1):41-9
references: 16172836
references: Behav Res Ther. 1987;25(2):123-8
references: 3593165
references: Obstet Gynecol. 1996 Mar;87(3):321-7
references: 8598948
references: J Urol. 2004 Oct;172(4 Pt 1):1242-8
references: 15371816
references: Behav Genet. 2005 Mar;35(2):177-88
references: 15685430
references: Pain. 2007 Nov;132 Suppl 1:S46-S51
references: 17257758
references: J Clin Epidemiol. 2008 Apr;61(4):344-9
references: 18313558
references: Am J Med Genet B Neuropsychiatr Genet. 2006 Jul 5;141B(5):449-62
references: 16741943
references: Psychosom Med. 1968 Nov-Dec;30(6):853-67
references: 5749738
references: Res Nurs Health. 1996 Feb;19(1):45-51
references: 8552802
references: Memory. 2009 Aug;17(6):609-23
references: 19585345
references: Behav Res Methods. 2007 May;39(2):175-91
references: 17695343
references: Pain. 2012 Jun;153(6):1148-1158
references: 22494920
references: Med Care. 2007 May;45(5 Suppl 1):S3-S11
references: 17443116
references: Headache. 2008 Sep;48(8):1157-68
references: 18808500
references: Am J Physiol Regul Integr Comp Physiol. 2006 Dec;291(6):R1592-601
references: 16946082
references: Assessment. 2011 Sep;18(3):263-83
references: 21697139
references: Clin J Pain. 2013 Oct;29(10):883-90
references: 23370073
references: Headache. 2006 Oct;46  Suppl 3:S144-6
references: 17034393
references: N Engl J Med. 2008 Apr 17;358(16):1692-9
references: 18420501
references: Arthritis Rheum. 2006 Jan;54(1):169-76
references: 16385512
references: Am J Obstet Gynecol. 2010 Jun;202(6):534.e1-6
references: 20022587
references: J Health Commun. 2011;16 Suppl 3:150-62
references: 21951249