Somatic symptoms in women with dysmenorrhea and noncyclic pelvic pain

Abstract

Somatic symptoms are a robust, transdiagnostic risk factor for pain conditions. However, the extent to which somatic symptoms contribute to the manifestation of the women's pain syndromes, such as dysmenorrhea and noncyclic pelvic pain (NCPP), is unclear due to high rates of co-occurrence. Therefore, the present study investigated the primary hypothesis that somatic symptoms would be elevated in NCPP and distinctly influence the relationship between dysmenorrhea and co-occurring NCPP. A secondary analysis was performed on cross-sectional questionnaire data from 1012 nonpregnant reproductive-aged women. Eligible analyzed participants (n = 834) were categorized into four groups: healthy, dysmenorrhea, NCPP, and NCPP with co-occurring dysmenorrhea (NCPP+dysmenorrhea). A parallel mediation analysis was run to evaluate the primary hypothesis that somatic symptoms are the primary factor associated with increased NCPP accounting for dysmenorrhea. The NCPP+dysmenorrhea group had higher somatic, anxiety, and depression symptom T-scores (respectively 61, 61, 60) compared to the healthy controls (46, 51, 51; p's < .001) and the dysmenorrhea group (50, 53, 54; p's < .001). The pain and psychological symptoms were significantly correlated across the entire sample (r's = .29, - .64, p's < .01). Results from parallel mediation analysis showed that somatic symptoms were distinctly associated with NCPP+dysmenorrhea. Women with NCPP+dysmenorrhea have increased psychological and somatic symptoms compared to women with dysmenorrhea alone. Given that NCPP often co-occurs with dysmenorrhea, failure to account for comorbidity in previous studies has likely led to an overestimation of psychological symptoms in dysmenorrhea. Future studies should evaluate whether somatic sensitivity is a modifiable risk factor for NCPP.

Keywords: Comorbidity; Dysmenorrhea; Noncyclic pelvic pain; Somatic symptoms.

Figure 1

Parallel Mediation Model for Pelvic Pain. Statistical diagram of parallel multiple mediator model (with three mediators: somatization, anxiety, and depression, and menstrual pain as a covariate). Significant pathways are red. The diagram shows A) the total effect of group (NCPP+dysmenorrhea contrasted to dysmenorrhea only) on Pelvic Pain and B) the direct effect and causal pathways associating group with pelvic pain. The NCPP+dysmenorrhea group had significantly higher scores on all psychopathology and pain variables. Independent of the influence of the mediators, group was directly associated with pelvic pain. Somatic symptoms mediated the relationship between group and pelvic pain. Beyond the significant effects of group and somatic symptoms, anxiety, depression, and menstrual pain were not independent predictors of pelvic pain.