Hypothesis / aims of study
Menstrual pelvic pain (dysmenorrhea) is a symptom associated with menstruation [1] that significantly disrupts daily activities. Evaluating and comparing prevalence across varying recall periods is crucial, current or recent menstrual pain tend to yield more accurate reports and longer recall periods (e.g., pain from up to a year ago) may lead to inaccuracies [2], resulting in inconsistent prevalence estimates. The prevalence of different types of menstrual pain/dysmenorrhea, according to recall time-points, has not been reported yet. Therefore, this systematic review aimed to summarize the global prevalence of dysmenorrhea according to different recall periods for dysmenorrhea assessment, and to compare the prevalence according to different time-points.
Study design, materials and methods
This is a secondary analysis from a systematic review (PROSPERO ID: CRD42023392384) that included results from six databases from July 2024 (Medline, EMBASE, Web of Science, SciELO, CINAHL, and LILACS). Studies published from 2000–2024 (regardless location) reporting dysmenorrhea prevalence were included. Menstrual pain/dysmenorrhea was classified as primary (PD) (menstrual pain immediately before and/or during menstruation, without any associated pelvic affection), secondary (SD) (presence of any pelvic affection, usually endometriosis, adenomyosis or myomas) or non-specific (dysmenorrhea was not classified by the authors). Risk of bias was assessed using the Joanna Briggs Institute tool. Meta-analyses were performed in RStudio®, with heterogeneity evaluated via the I² statistic. Differences were evaluated using the Cochran's Q test. The subgroup analyses examined prevalence based on recall periods: current pain, pain over the past one month, three months, six months, and one year.
Results
A total of 336 studies were included in the primary systematic review, with 79 reporting recall-time related to menstrual pain across different regions: Asia (37 studies), Africa (16), Europe (11), South America (8), and North America (7). The global pooled prevalence for perceived pain during the current menstrual period was 71%. Prevalence for other recall periods was 64% for the last month, 66% for the last three months, 71% for the last six months, and 64% for the past year, with no significant differences found between recall periods. For primary dysmenorrhea (PD), the prevalence was 80% over the past six months, 72% for the past three months, and 78%-80% for the current and past month, with no significant differences between time points. For secondary dysmenorrhea (SD), the prevalence estimates ranged from 97% over the past year to 53% in the past month and 19% in the last six months. Most of the studies had a high risk of bias.
Interpretation of results
Although the literature suggests that variations in recall time can affect the accuracy of reports, particularly due to recall bias [1], the findings of the present study indicate consistency in self-reported symptoms of different types of menstrual pain worldwide. Prevalence remained high across the different time points, reinforcing the urgent need to prioritize the management of this symptom in public health care. Moreover, the results demonstrated the reliability of self-reported menstrual pain data despite potential recall limitations.
Evidence from this study supports better resource allocation to improve care and promote sustainable health development. Additionally, more high-quality studies are needed to explore menstrual pain prevalence in diverse populations.