Document Type : Research Article


1 Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

2 Menopause Andropause Research Center, Department of Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


Background: Primary dysmenorrhea is one of the most prevalent issues in women’s health care, which affects half of the population in the reproductive age. The present research aimed to evaluate the severity of primary dysmenorrhea and its associated characteristics among the university students in Ahvaz, Iran.
Methods: In this cross-sectional descriptive study, 80 college students suffering from dysmenorrhea were randomly recruited. All the required data were gathered via demographic questionnaire, Visual Analoge Sclae (VAS), Pictorial Blood Assessment Chart (PBAC), and Symptom Severity Score (SSS) during two consecutive menstrual cycles from Aprill 20 to June 20, 2016. Furthermore, descriptive statistics (frequency and mean) and analytical statistics (Pearson’s correlation coefficient) were used. P<0.05 was considered as the level of significance.
Results: The mean±SD of menstrual pain of the participants was 6.6±1.5 out of 10. Most of them (61.2%) suffered from moderate dysmenorrhea. Mean±SD of their age was 21.1±2.0 years and their age at menarche was 12.9±1.2 years. A significant number of the participants (85%) claimed to use drugs to relieve the menstrual pain, with the most common onebeing Ibuprofen (41.2%), usually taken orally at the onset of menstruation. Moreover, analysis of the results revealed a significant correlation among all the items of Symptom Severity Score (SSS) and pain severity (P<0.001), except sensitivity and depression. However, the duration and amount of menstrual bleeding was not significantly correlated with pain severity.
Conclusions: Choosing the right approach to managing and educating women with menstrual pain-associated symptoms can reduce the adverse impact of dysmenorrhea on their quality of life.


1. Burnett M, Lemyre M. No. 345-Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2017;39(7):585–595. doi: 10.1016/j.jogc.2016.12.023. PubMed PMID: 28625286. ## 2. Dmitrovic R, Peter B, Cvitkovic-Kuzmic A, Strelec M, Kereshi T. Severity of symptoms in primary dysmenorrhea:a Doppler study. Eur J Obstet Gynecol Reprod Biol. 2003;107(2):191–4. doi: 10.1016/s0301-2115(02)00372-x. PubMed PMID: 12648867. ## 3. Osayande A.S, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014;89(5):341–6. PubMed PMID: 24695505. ## 4. Shah M, Monga A, Patel S, Shah M, Bakshi H. A study of prevalence of primary dysmenorrhea in young students-A cross-sectional study. Healthline. 2013;4(2):30–4. ## 5. Hall JE. Menstrual disorders and pelvic pain. In Longo DL, Fauci AS, Kasper DL, editors. Harrison’s Online. 18th ed. New York, NY: McGraw-Hill; 2012. ## 6. Harel Z. Dysmenorrhea in adolescents. Ann N Y Acad Sci. 2008;1135:185–195. doi: 10.1196/annals.1429.007. PubMed PMID: 18574224. ## 7. Fernández-Martínez E, Onieva-Zafra M.D, Parra-Fernández M.L. The Impact of Dysmenorrhea on Quality of Life Among Spanish Female University Students. Int J Environ Res Public Health. 2019;16(5):713. doi: 10.3390/ijerph16050713. PubMed PMID: 30818861; PubMed Central PMCID: PMC6427338. ## 8. O’Connell K, Davis AR, Westhoff C. Self-treatment patterns among adolescent girls with dysmenorrhea. J Pediatr Adolesc Gynecol. 2006;19(4):285-9. doi: 10.1016/j.jpag.2006.05.004. PubMed PMID: 16873033. ## 9. Hayes EC, Rock JA. COX-2 inhibitors and their role in gynecology. Obstet Gynecol Surv. 2002;57(11):768–80. doi: 10.1097/00006254-200211000-00023. PubMed PMID: 12447099. ## 10. Dell DL. Premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual exacerbation of another disorder. Clin Obstet Gynecol. 2004;47(3):568–75. doi: 10.1097/01.grf.0000135298.39050.b3. PubMed PMID: 15326419. ## 11. Chan WY, Hill JC. Determination of menstrual prostaglandin levels in non-dysmenorrheic and dysmenorrheic subjects. Prostaglandins. 1978;15(2):365–75. doi: 10.1016/0090-6980(78)90176-4. PubMed PMID: 635225. ## 12. Chan WY, Dawood MY, Fuchs F. Relief of dysmenorrhea with the prostaglandin synthetase inhibitor ibuprofen: effect on prostaglandin levels in menstrual fluid. Am J Obstet Gynecol. 1979;135(1):102–8. PubMed PMID: 474640. ## 13. Dawood MY. Hormones, prostaglandin and dysmenorrhea. In Dawood MY, editor. Dysmenorrhea. Baltimore (MD): Williams and Wilkins; 1981. p. 20–52. doi: 10.2165/00003495-198122010-00003. ## 14. Fajrin I, Alam G, Usman A.N. Prostaglandin level of primary dysmenorrhea pain sufferers. Enferm Clin. 2020;30:5–9. doi: 10.1016/j.enfcli.2019.07.016. ## 15. Mohammad-Alizadeh Charandabi S, Mirghafourvand M, Nezamivand-Chegini S, Javadzadeh Y. Calcium with and Without Magnesium for Primary Dysmenorrhea: A Double-Blind Randomized Placebo Controlled Trial. IJWHR. 2017;5(4):332–338. doi: 10.15296/ijwhr.2017.56. ## 16. Mohammad-Alizadeh Charandabi S, Mirghafourvand M, Javadzadeh Y, Nezamivand-Chegini S. Effects of Calcium and its Combination with Magnesium on the Severity of Menstrual Symptoms in the Students with Dysmenorrhea. J of Guilan University of Med Sci. 2014;22(S1):83-92. Persian. ## 17. Mohammad Alizadeh Charandabi S, Mirghafourvand M, Javadzadeh Y, Nezamivand Chegini S. Effect of Calcium with and Without Magnesium on Amount and Duration of Menstrual Bleeding in Students with Primary Dysmenorrhea. IJOGI. 2014;16(83):1-8. doi: 10.22038/IJOGI.2014.2263. ## 18. Reid PC, Coker A, Coltart R. Assessment of menstrual blood loss using a pictorial chart: a validation study. BJOG. 2000;107(3):320-2. doi: 10.1111/j.1471-0528.2000.tb13225.x. PubMed PMID: 10740326. ## 19. Chan WY, Dawood MY, Fuchs F. Prostaglandins in primary dysmenorrhea. Comparison of prophylactic and nonprophylactic treatment with ibuprofen and use of oral contraceptives. Am J Med. 1981;70(3):535–41. doi: 10.1016/0002-9343(81)90576-3. PubMed PMID: 7011011. ## 20. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: A critical review. Hum Reprod Update. 2015;21(6):762–78. doi: 10.1093/humupd/dmv039. PubMed PMID: 26346058. ## 21. Lefebvre G, Pinsonneault O, Antao V, Black A, Burnett M, Feldman K, et al. Primary dysmenorrhea consensus guideline. J Obstet Gynaecol Can. 2005;27(12):1117-46. doi: 10.1016/s1701-2163(16)30395-4. PubMed PMID: 16524531. ## 22. Eryilmaz G, Ozdemir F, Pasinlioglu T. Dysmenorrhea prevalence among adolescents in eastern Turkey: its effects on school performance and relationships with family and friends. J Pediatr Adolesc Gynecol. 2010;23(5):267-72. doi: 10.1016/j.jpag.2010.02.009. PubMed PMID: 20493741. ## 23. Dambhare DG, Wagh SV, Dudhe JY. Age at menarche and menstrual cycle pattern among school adolescent girls in Central India. Glob J Health Sci. 2012;4(1):105-11. doi: 10.5539/gjhs.v4n1p105. PubMed PMID: 22980118; PubMed Central PMCID: PMC4777020. ## 24. Campbell MA, McGrath PJ. Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med. 1997;151(9):905-13. doi: 10.1001/archpedi.1997.02170460043007. PubMed PMID: 9308868. ## 25. Armour M, Parry K, Al-Dabbas MA, Curry C, Holmes K, MacMillan F, et al. Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and meta-analysis. PLoS One. 2019;14(7):e0220103. doi: 10.1371/journal.pone.0220103. PubMed PMID: 31339951; PubMed Central PMCID: PMC6655766. ## 26. Vicdan K, Kukner S, Dabakoglu, Ergin T, Keles G, Gokmen O. Demographic and epidemiologic features of female adolescents in Turkey. J Adolesc Health. 1996;18(1):54-8. doi: 10.1016/1054-139x(95)00127-e. PubMed PMID: 8750429. ## 27. Demir SC, Kadayýfçý TO, Vardar MA, Atay Y. Dysfunctional uterine bleeding and other menstrual problems of secondary school students in Adana, Turkey. J Pediatr Adolesc Gynecol. 2000;13(4):171-5. doi: 10.1016/s1083-3188(00)00061-9. PubMed PMID: 11173019. ## 28. Ersoy B, Balkan C, Gunay T, Onag A, Egemen A. Effects of different socioeconomic conditions on menarche in Turkish female students. Early Hum Dev. 2004;76(2):115–25. doi: 10.1016/j.earlhumdev.2003.11.001. PubMed PMID: 14757263. ## 29. De Sanctis V, Soliman A.T, Elsedfy H, Soliman N.A, Elalaily R, El Kholy M. Dysmenorrhea in adolescents and young adults: A review in different country. Acta Biomed. 2016;87(3):233–246. PubMed PMID: 28112688. ## 30. Singh A, Kiran D, Singh H, Nel B, Singh P, Tiwari P. Prevalence and severity of dysmenorrhea: a problem related to menstruation, among first and second year female medical students. Indian J Physiol Pharmacol. 2008;52(4):389-97. PubMed PMID: 19585756. ## 31. Kural M, Nagori Noor N, Pandit D, Joshi T, Patil A. Menstrual characteristics and prevalence of dysmenorrhea in college going girls. J Family Med Prim Care. 2015;4(3):426–31. doi: 10.4103/2249-4863.161345. PubMed PMID: 26288786; PubMed Central PMCID: PMC4535108. ## 32. Akhavanakbari P, Ahangar Davoudi SH. Dysmenorrhea Frequency and Severity and Its Related Factors in Students of Ardabil University of Medical Science in 1388. Journal of Health. 2011;1(3):41-47. Persian. ##