Investigation of dysmenorrhea in adolescent girls with familial Mediterranean fever: a comparative study with healthy controls

Abstract

Perimenstrual attacks have been reported in up to 15% of patients with FMF, suggesting that menstruation may be a trigger for FMF attacks. The aim of this study was to investigate menstrual period patterns and dysmenorrhea in adolescents with FMF in comparison to their healthy peers. This cross-sectional case-control study included 73 FMF patients and 70 age- and body mass index-matched controls. A structured questionnaire was designed to assess menstrual history, the frequency and severity of dysmenorrhea, symptoms related to dysmenorrhea, and the clinical features of FMF attacks. Dysmenorrhea was present in 90.4% of patients and 95.7% of controls (p = 0.32). Pain was reported during every cycle or every two cycles by 83.3% of patients versus 65.6% of controls (p = 0.02). Fever (27.4% vs. 10.3%, p = 0.01) was significantly more frequent in patients, while musculoskeletal symptoms (46.6% vs. 66.2%, p = 0.02), fatigue (53.4% vs. 83.8%, p < 0.001), and sleep disturbances (19.2% vs. 50.7%, p < 0.001) were more common in controls. Notably, FMF patients reported heavier bleeding episodes with higher number of sanitary pads used during menstruation (p = 0.001). Menstruation-associated FMF attacks were reported by 37% of patients, with 14.8% experiencing them every cycle. Exon 10 variants were present in 86.3% of cases, with 23.3% being homozygous. The frequency and character of dysmenorrhea did not differ significantly according to genetic profiles.

Conclusions: This study is the first to investigate menstrual patterns and dysmenorrhea symptoms in adolescent FMF patients compared to their healthy peers. Dysmenorrhea is prevalent in FMF patients with distinct menstrual characteristics, including more frequent fever and heavier bleeding.

What is known: • Menstruation may trigger Familial Mediterranean Fever (FMF) attacks in a subset of patients, but the relationship between FMF and dysmenorrhea remains unclear. • Some studies suggest that inflammation associated with FMF could contribute to menstrual pain and abnormalities, but comprehensive data in adolescents are limited.

What is new: • This study is the first to compare menstrual patterns and dysmenorrhea characteristics between adolescent FMF patients and healthy controls, highlighting distinct menstrual symptoms in FMF patients. • FMF patients experience more frequent febrile episodes and heavier menstrual bleeding compared to their healthy peers, but dysmenorrhea characteristics are not influenced by specific MEFV gene mutations.

Keywords: Adolescents; Dysmenorrhea; Familial Mediterranean fever; Menstruation.

Fig. 1

Distribution of symptoms accompanying dysmenorrhea in patients with and without menstruation associated FMF attacks who had dysmenorrhea during menstrual bleeding; *p < 0.05 statistically significant difference. ¹Includes responses quite limited and limited for the effect of dysmenorrhea on quality of life