Understanding Dysmenorrhea in Individuals with Polycystic Ovary Morphology (PCOM)

Paola Romeo, Shay M. Freger, K. McGowan, Mathew Leonardi
In: Journal of Endometriosis and Uterine Disorders · 2025 · vol. 12 , pp. 100131 · doi:10.1016/j.jeud.2025.100131 · W4413123062
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This study found that severe dysmenorrhea is highly prevalent in individuals with PCOM, with heavy menstrual flow strongly predicting pain severity, while gravidity appears protective.

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Abstract

• High prevalence of severe dysmenorrhea in patients with PCOM. • Heavy menstrual flow strongly predicts severe dysmenorrhea. • Gravidity appears protective against severe menstrual pain. • PCOM identified in nearly 20% of gynecologic ultrasounds. • Findings support targeted assessment for PCOM-related dysmenorrhea. Dysmenorrhea and polycystic ovarian morphology (PCOM) are prevalent gynecological conditions with significant impacts on quality of life. Although traditionally viewed as separate entities, emerging evidence suggests a potential association. This study assessed the prevalence and severity of dysmenorrhea among individuals with PCOM and identified risk factors for severe dysmenorrhea. We conducted a retrospective observational study at a gynecologic ultrasound clinic in Hamilton, Canada, including patients aged 20–45 years diagnosed with PCOM between February and June 2023. PCOM was defined by ≥20 follicles and/or ovarian volume >10 mL without a dominant follicle, cyst, or corpus luteum. Dysmenorrhea severity was self-reported via a visual analogue scale (VAS; 0–10), with VAS ≥ 6 indicating severe dysmenorrhea. Statistical analyses included univariate comparisons and logistic regression. Among 1,321 scans, 243 patients (18%) had PCOM; 208 met inclusion criteria. Severe dysmenorrhea was reported by 61% (127/208). Univariate analysis linked severe dysmenorrhea with younger age, higher weight, heavy menstrual flow, dyspareunia, and infertility history; gravidity and previous pregnancies were protective. Logistic regression identified heavy menstrual flow (OR 16.32; p < 0.001) and referral for advanced endometriosis ultrasound (OR 4.34; p = 0.021) as independent risk factors, while gravidity was protective (OR 0.38; p = 0.016). Nearly 1 in 5 patients undergoing gynecologic ultrasound presented with PCOM, and a majority reported severe dysmenorrhea. Heavy menstrual flow and gravidity emerged as key factors influencing severity. These findings underscore the importance of targeted clinical assessment and raise questions about PCOM as a contributor to menstrual pain independent of polycystic ovary syndrome.

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Outcome instruments

VAS-pain

Condition tags

endometriosisdysmenorrheadyspareuniainfertility

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