Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis

Abstract

This study aimed to identify factors associated with the prevalence and severity of menstrual-related symptoms. The protocol was registered in PROSPERO (CRD42021208432). We conducted literature searches of PubMed and Ichushi-Web and used the Jonna Briggs Institute critical appraisal checklist to assess the quality. Of the 77 studies included in the meta-analysis, significant odds ratios (ORs) were obtained for eight factors associated with primary dysmenorrhea (PD): age ≥ 20 years (OR: 1.18; 95% confidence interval [CI]: 1.04−1.34), body mass index (BMI) < 18.5 kg/m2 (OR: 1.51; 95% CI: 1.01−2.26), longer menstrual periods (OR: 0.16; 95% CI: 0.04−0.28), irregular menstrual cycle (OR: 1.28; 95% CI: 1.13−1.45), family history of PD (OR: 3.80; 95% CI: 2.18−6.61), stress (OR: 1.88; 95% CI: 1.30−2.72), sleeping hours < 7 h (OR: 1.19; 95% CI: 1.04−1.35), and bedtime after 23:01 (OR: 1.30; 95% CI: 1.16−1.45). Two factors were associated with severity of PD (moderate vs. severe): BMI < 18.5 kg/m2 (OR: 1.89; 95% CI: 1.01−3.54) and smoking (OR: 1.94; 95% CI: 1.08−3.47). PD severity (mild vs. severe) and prevalence of premenstrual syndrome were associated with BMI < 18.5 kg/m2 (OR: 1.91; 95% CI: 1.04−3.50) and smoking (OR: 1.86; 95% CI: 1.31−2.66), respectively. The identified risk factors could be utilized to construct an appropriate strategy to improve menstrual symptoms and support women’s health.

Keywords: menstrual-related symptoms; premenstrual syndrome; primary dysmenorrhea; risk factors.

Figure 1

Flow diagram of literature search.

Figure 2

Forest plot showing a meta-analysis of studies comparing the number of women aged ≥20 years with and without PD [5,6]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 3

Forest plot showing a meta-analysis of studies comparing the number of women with BMI < 18.5 kg/m² with and without PD [5,6,38,68]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 4

Forest plot showing a meta-analysis of studies comparing menstrual days with and without PD [9,10,28,38,83]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 5

Forest plot showing a meta-analysis of studies comparing the number of women who have irregular menstrual cycles with and without PD [6,28,83]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 6

Forest plot showing a meta-analysis of studies comparing the number of women who have a family history of PD with and without PD [5,28,34,66]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 7

Forest plot showing a meta-analysis of studies comparing the number of women with and without PD who have higher stress levels [5,83]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 8

Forest plot showing a meta-analysis of studies comparing the number of women with and without PD sleeping < 7 h [6,20]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 9

Forest plot showing meta-analysis of studies comparing the number of women with and without PD who go to bed at 23:01 or later [6,20]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 10

Forest plot showing a meta-analysis of studies comparing the number of women with BMI < 18.5 kg/m² by the severity of PD (severe vs. moderate) [58,68]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 11

Forest plot showing a meta-analysis of studies comparing the number of women with a smoking habit by the severity of PD (severe vs moderate) [34,66]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 12

Forest plot showing a meta-analysis of studies comparing the number of women with BMI < 18.5 kg/m² by the severity of PD (severe vs. mild) [58,68]. The analysis was performed using a random-effects model. PD, primary dysmenorrhea. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.

Figure 13

Forest plot showing a meta-analysis of studies comparing the number of women with and without PMS with a smoking habit [32,43,70]. The analysis was performed using a random-effects model. PMS, premenstrual syndrome. The black diamond and its extremities indicate the pooled risk ratio center and a 95% confidential interval.