Evaluating the Impact of Dysmenorrhea on Quality of Life

Dysmenorrhea is perhaps the most disruptive aspect of heavy menstrual bleeding (HMB), marked by severe cramping and pelvic pain during menses that interferes with a woman’s quality of life. Current estimates report that 50-90% of women suffer from dysmenorrhea, making it the most common condition shared with gynecologists.¹ In fact, the World Health Organization (WHO) named chronic pelvic pain a “neglected reproductive health morbidity” due to the multifaceted and debilitating impact it has on a woman’s ability to carry out normal tasks during her period.²

Similar to excessive bleeding, dysmenorrhea is difficult to quantify and empirically evaluate in clinical practice.³ In order to determine pathological nature, clinicians often use quality of life (QOL) scales as the standard metric to analyze how menstrual cramping affects factors such as physical health, psychological well-being, social engagement, and functional ability.⁴ On the whole, patients with dysmenorrhea present with significantly lower QOL scores than patients without menstrual pain.⁴ Specifically, these scores include:

Impact #1 | Physical Health

The hallmark of dysmenorrhea is pain, and up to 50% of patients with dysmenorrhea describe their pain as severe.¹ Likewise, up to one-third of patients suffer from comorbidities such as gastrointestinal upset, fatigue, headache, reduce sleep quality, and poor mental health.¹ Moreover, the pathophysiological changes during menses, including heightened prostaglandin production, can alter pain processing mechanisms and amplify pain sensitization in the central nervous system.⁴

The severe physical impacts of dysmenorrhea are exacerbated by high pain severity as well as a delay in diagnosis and treatment. According to one study, patients with dysmenorrhea are 2.5 times more likely to develop chronic pelvic and non-pelvic pain.⁵ Due to its chronic nature, the pain and side effects of dysmenorrhea have a compounding effect, especially for those who do not receive proper treatment for HMB.

Impact #2 | Psychological Well-Being

Dysmenorrhea has a bidirectional relationship with mental health disorders.¹ Not only does chronic, severe pain impact mood and increase stress, but certain psychological changes (depression, anxiety, and stress-related disorders) can magnify a patient’s perception of her reduced social activity and functional capacity.¹ One meta-analysis found that women with dysmenorrhea were at a 1.72 times higher risk of depressive symptoms, with over one-quarter of subjects reporting depression events.⁶ Based on patient-reported physical and psychological scores, the damage to quality of life from dysmenorrhea is comparable to other chronic conditions, such as cystic fibrosis.¹

Impact #3 | Social Engagement

Due to debilitating pain, patients with dysmenorrhea often cannot participate in social activities, hobbies, or family/relationship engagements. One study of over 1,800 participants found that dysmenorrhea impacted the ability to engage in work, school, and social activities in up to 89% of patients, with 10-20% of patients reporting an extreme impact on these functions.⁷ In addition to severe menstrual cramping, 93% of these patients experienced non-pelvic symptoms, including mood changes, bloating, constipation, and diarrhea — symptoms that further impacted their ability to maintain an active social life.⁷ Reduced social engagement, as seen in most dysmenorrhea patients, can heighten feelings of isolation, causing even greater damage to mental health and wellness.

Impact #4 | Functional Ability & Productivity

Dysmenorrhea not only impacts quality of life as a whole but day-to-day functioning as well. Patients face functional limitations both at home and in the workplace, struggling to perform household tasks and maintain workplace productivity. One survey found that 13.8% of women report absenteeism during their periods, with some having to stay home almost every cycle.⁸ Likewise, more than 80% of respondents report presenteeism, with a 33% loss of productivity equating to 8.9 total lost days of productivity.⁸ Based on physical, social, and mental complications, the quality-adjusted life year loss of dysmenorrhea mirrors type 1 diabetes, asthma, atopic eczema, and chronic migraines.¹ 

How the Cerene® Cryotherapy Device Can Help

Dysmenorrhea wreaks havoc on every aspect of a patient’s life. That’s why, according to market research, 86% of women suffering from menorrhagia define treatment success as a normalization of their periods in addition to relief from menstrual cramping.⁹ As an FDA-approved endometrial ablation device, Cerene employs cryotherapy to treat HMB by decreasing blood loss and significantly reducing dysmenorrhea. Through cryoablation with nitrous oxide, OBGYNs can use Cerene to deliver a safe and well-tolerated ablation procedure that reduces dysmenorrhea in 86% of patients,^† helping women experience a higher quality of life and live life with little to no interruptions. 

Interested in learning more about how Cerene can deliver the much-needed relief your patients are looking for? Learn more at https://cerene.com/healthcare-professionals/ 

† Improvement reported one year after treatment for patients reporting severe/very severe period pain

Key Takeaways: 

• Dysmenorrhea is a very common gynecologic condition that presents alongside heavy menstrual bleeding (HMB) and significantly reduces quality of life.
• Specifically, dysmenorrhea results in poorer physical health, increases the risk of depression and anxiety, reduces the ability to engage in social activities, and lowers functional ability at home and in the workplace.
• Cerene is an FDA- approved endometrial cryoablation device with nitrous oxide that is clinically proven to reduce dysmenorrhea in 86% of patients.

Sources

1. MacGregor, B., Allaire C., Bedaiwy, M.A., Yong P.J., Bougie, O. (2023). Disease Burden of Dysmenorrhea: Impact on Life Course Potential. International Journal of Women’s Health 2023(15), 499-509.
2. Latthe, P., Latthe, M., Say, L., Gülmezoglu, M., Khan, K.S. (2006). WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 6(177).
3. Quinn, S.D., & Higham, J. (2016). Outcome measures for heavy menstrual bleeding. Women’s Health (London, England) 12(1), 21-26.
4. Iacovides, S., Avidon, I., Bentley, A., Baker, F.C. (2014). Reduced quality of life when experiencing menstrual pain in women with primary dysmenorrhea. Acta Obstetricia et gynecologica Scandinavica 93(2), 213-217.
5. Li, R., Li, B., Kreher, D.A., Benjamin, A.R., Gubbels, A., Smith, S.M. (2020). Association between dysmenorrhea and chronic pain: a systematic review and meta-analysis of population-based studies. American Journal of Obstetrics and Gynecology 223(3), 350-371. 
6. Zhao, S., Wu, W., Kang, R., Wang, X. (2021). Significant Increase in Depression in Women With Primary Dysmenorrhea: A Systematic Review and Cumulative Analysis. Frontiers in Psychiatry 12, 686514.
7. Rencz, F., Péntek, M., Stalmeier, P.F.M., Brodszky, V., Ruzsa, G., Gradvohl, E., Baji, P., Gulácsi, L. (2017). Bleeding out the quality-adjusted life years: evaluating the burden of primary dysmenorrhea using time trade-off and willingness-to-pay methods. Pain 158(11), 2259-2267.
8. Schoep, M.E., Adang, E.M.M., Maas, J.W.M., De Bie, B., Aarts, J.W.M., & Nieboer, T.E. (2019). Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ Open 9(6), e026186. 
9. Data on file. Channel Medsystems Market Research Iris Survey 2014.