Primary dysmenorrhea among female medical students at Haramaya university: a cross sectional study in Harar, Eastern Ethiopia.

The study was conducted from December 1 to 30, 2023 at Haramaya University, College of health and medical science (CHMS). The college is located in Harar town 525 km East of Addis Ababa. Currently, there are a total of 1930 students actively attending their studies, of which 707 are female students. The college has a total of seven departments within the school of public health and school of medicine. The current study was conducted to assess prevalence and associated factors of primary dysmenorrhea among undergraduate regular female medical students’ of the College of Health and Medical Science, Harar, Ethiopia. All female students of CHMC at Haramaya University students were the source population. All undergraduate regular female medical students of CHMC at Haramaya University who were available during the study period were the study population. Regular Female students of CHMS. No known gynecologic disorder (determined through self-reported medical history by students). Non-regular female students of CHMS. Involuntary to participate in the study. Had known gynecologic disorder. The sample size for this study was calculated using Epi info Version 7.2.5.0 software and the population proportion formula based on the following assumption; Design effect = 1.8, a 95% Confidence Interval, Power = 80%, and the ratio of unexposed to exposed almost equivalent to1; the final sample size was 254. The largest sample size found was 396 from the second objective. Since our study population was less than ten thousand we used the finite population correction formula and it was calculated as follows: n0 = sample from finite population = 396, n = sample size = 254. N = population size = 707. D = Design effect = 1.8 Final sample size = n*D = 254*1.8 = 457, by adding 10% non-response rate, the sample size = 457 + 46 = 503. In this study we have used multistage cluster sampling technique to select the study participant. From seven study departments of Haramaya University CHMS four study departments were selected by simple random sampling technique and the required sample size were proportionally allocated to all selected department. Then, out of all selected departments, class year was selected randomly and the sample size was proportionally allocated to all selected class year. For all selected class year sampling frame were developed based on student ID number. Finally, from each class year eligible study subjects were selected using systematic random sampling technique (Fig.  1 ). Fig. 1 schematic diagram showing sampling procedures of the study participants in the study area. schematic diagram showing sampling procedures of the study participants in the study area. Primary dysmenorrhea. Socio-demographic variables : age, marital status, occupation, and educational level. Behavioural factors : smoking, alcohol consumption, tea consumption, coffee consumption, and coca-cola/ pepsi consumption. Psychosocial factors : poor mental health like depression and anxiety, disruption of social network and studying area stress. Mental health- prior studies show history of anxiety had a strong association with primary dysmenorrhea. Hence, research questions like long period of studying, tightly controlled schedule and sleepless night duty, unsecured living dormitory were used to examine it. Disruption of social network has been inferred from questions about social support, living arrangement and unsecured living dormitory. Gynecologic factors : Age at menarche (year), Menstrual regularity, heavy menstrual blood flow, Family history of dysmenorrhea, Nulliparity. Data collection was conducted after data collectors and supervisors were trained for three days on the data collection tool, consent form, and data collection procedure by the principal investigator. Data were collected using a self-administered questionnaire. The questionnaire was pre-tested (5% of the total sample size) on female medical students at Dire-Dawa University. The purpose of the pre-test was to ensure that respondents could understand the questions, check the wordings and logical sequence, and skip patterns of the questions rationally. Modifications to the questionnaire were made accordingly after the pre-test. The supervisors checked all the filled questionnaires for their completion, clarity, and proper identification of the respondents. To ensure the quality, reliability, accuracy, and completeness of the collected data, daily supervision was made during the data collection process by supervisors and principal investigators. Double data entries were done by two data clerks and the consistency of the entered data was cross-checked by comparing the two separately entered data on EPI Data. Finally, multivariable analyses were carried out with a binary logistic regression model to control the confounding factors. The collected and checked data were coded and entered into Epi data version 3.1 and exported to STATA version 17 for cleaning and statistical analysis. Descriptive analysis such as frequency distribution was done to describe the characteristics of participants. Bivariableand multivariable analysis was done to see the association between each independent variables and outcome variables by using binary logistic regression. All variables with p  < 0.25 in the bivariable analysis were included in the final model of multivariable analysis in order to control all possible confounders. The assumption of binary logistic regression include; model fitness were checked by Hosmer–Lemeshow goodness of fit and Multicolinearity test to see the correlation between independent variables by using the standard error and collinearity statistics (variance inflation factors > 10 and standard error > 2 were considered as suggestive of existence of multi co-linearity).The direction and strength of statistical association were measured by odd ratio with 95%CI. Adjusted odds ratio along with 95% CI was estimated to identify associated factors of primary dysmenorrhea by using multivariable analysis in binary logistic regression. In this study, P -value < 0.05 was considered statistically significant. Primary dysmenorrhea : is considered if an adolescent had pain in the abdominal, groin, and lumbar region on the day before the menstrual period and/or the first day of menstrual period, with no pelvic pathology 21 . Multidimensional scoring system (MSS) : is used to assess the severity of primary dysmenorrheal pain as mild, moderate and sever based on pain and limited physical activities 22 . Grade 0 , primary dysmenorrheal status: Menstruation is not painful and daily activity is not affected 5 . Mild (Grade 1) primary dysmenorrheal status: Menstruation is painful but rarely inhibits normal activity; analgesics are rarely required 5 . Moderate (Grade 2) primary dysmenorrheal status: Daily activity is affected; analgesics required and give sufficient relief so that absence from school is uncommon 5 . Severe (Grade 3) primary dysmenorrheal status: Activity clearly inhibited; poor effect of analgesics with vegetative symptoms like headache, fatigue, vomiting, and diarrhea 5 .

In this study, a total of 498 study participants participated and making response rate 99%. From 498 participants included in analysis, majority 466 (93.57%) were single and 416 (83.53%) were 19–24 age group with median age of 23 (± 2 IQR). More than two third of female students 346 (69.49%) had studying area stress. Regarding personal habits, more than half 307 (61.65%) consume coffee < 3 cup/day and 287 (57.63%) consume tea < 4 glass/day respectively most all 495 (99.40) and 445 (89.36) had no smoking cigarette and drinking alcohol habits (Table 1 ). Table 1 Socio-demographic characteristics, life style and personal habits of undergraduate female medical students, at Haramaya University, Ethiopia, 2023. Variables Category Frequency(n = 498) Percentage (%) Age 19–24 416 83.53 25–30 82 16.47 Marital status Single 466 93.57 Married 27 5.42 Divorced 3 0.60 Widowed 2 0.40 Religion Orthodox 201 40.36 Muslim 154 30.92 Protestant 89 17.87 Catholic 21 4.22 Others 33 6.63 Departments of study Medicine 214 42.97 Medical lab 92 18.47 Pharmacy 132 26.51 Health officer 60 12.05 Ethnicity Oromo 180 36.15 Amhara 95 19.08 Tigre 54 10.84 Guragae 78 15.66 Other 91 18.27 Academic year 1st year 63 12.65 2nd year 95 19.08 3rd year 149 29.92 4th year 112 22.49 5th year 66 13.25 6th year 13 2.61 Body mass index Underweight 17 3.41 Normal 354 71.08 Overweight 103 20.68 Obese 24 4.82 History of anxiety No 275 55.22 Yes 223 44.78 Disruption from social networks No 352 70.68 Yes 146 29.32 Studying area stress No 152 30.52 Yes 346 69.49 Cigarette smoking Not at all 495 99.40 One cigarette/ day 3 0.60 Alcohol drinking Never drunk 445 89.36 I drunk (2–3 in a month) 53 10.64 Tea consumption Not at all 204 40.96   4 glass/day 7 1.41 Coffee consumption Not at all 144 28.92   3 cup/day 47 9.44 Coca-Cola consumption Not at all 242 48.59 One per day 235 47.19  > 1/day 21 4.22 Chocolate consumption Not at all 217 43.57 2 bars of chocolate/day 240 48.19  > 2 bars of chocolate/day 41 8.23 Socio-demographic characteristics, life style and personal habits of undergraduate female medical students, at Haramaya University, Ethiopia, 2023. About 346 female medical students had studying area stress; tightly controlled schedule (80.35%), long period of studying (75.14%) and bulky subject to study (74.28%) were the most common cause. Whereas, sleepless night duty (13.1%) and overloaded patient care (10.4%) was the least cause of studying area stress (Fig.  2 ). Fig. 2 Reason of studying area stress. Reason of studying area stress. Around (58.63%) of female medical student’s ages at menarche were > 12 years, and 287 (57.63%) of them had regular types of menstruation. From total study participants, almost all 483(96.99%) and 458(91.97) were nulliparous and changed 2–3 pads/day respectively. More than three-fourths of female medical students, 396 (79.52%), had their menstruation at intervals of 21–35 days. Additionally, out of total study participants, more than two-thirds 194 (38.96%) of them had a family history of dysmenorrhea (Table 2 ). Table 2 Reproductive characteristics and menstrual pattern of undergraduate female medical students, at Haramaya University, Ethiopia, 2023. Variables Category Frequency(n = 498) Percentage (%) Age at menarche   12 years 292 58.63 Duration of menstrual flow   5 days 22 4.42 Number of pads changed per day 1 pads/day 16 3.21 2–3 pads/day 458 91.97  > 3 pads/days 24 4.82 Volume per day Scanty 14 2.81 Average 379 76.10 Heavy 105 21.08 Type of menstruation Regular 287 57.63 Irregular 211 42.37 Interval of menstruation   35 days 74 14.86 Family history of dysmenorrhea Yes 194 38.96 No 304 61.04 Parity Nullipara 483 96.99 Multipara 15 3.01 Contraceptive use No 476 95.58 Yes 22 4.42 Reproductive characteristics and menstrual pattern of undergraduate female medical students, at Haramaya University, Ethiopia, 2023. Among 300 female medical students with pain during menstruation, only 69 (23%) had severe pain. Considering the onset of menstrual pain, 132 (44%) of them experienced it on the first day of the menstrual period, and the majority of them, 241 (80.33%) had an associated symptom. The most common associated symptom was back pain (74%), mood change (67%) and headache (66%). Whereas, among 262 (87.33%) of female medical students with pain, all daily activity were affected, and analgesics were required (Table 3 ). Table 3 Pain severity, associated symptom and consequences on daily activities of Undergraduate Female Medical Students, at Haramaya University, Ethiopia, 2023. Variables Category Frequency(n = 300) Percentage (%) Severity of pain Mild pain 93 31.00 Moderate pain 138 46.00 Severe pain 69 23.00 Associated symptom No 59 19.67 Yes 241 80.33 Back pain No 78 26.00 Yes 222 74.00 Headache No 102 34.00 Yes 198 66.00 Mood change No 98 32.67 Yes 202 67.33 Sleeplessness No 157 52.33 Yes 143 47.67 Pain at the groin No 147 49.00 Yes 153 51.00 Diarrhea, Nausea, Vomiting No 141 47.00 Yes 159 53.00 Menstrual pain occur One day before menstrual period 102 34.00 First day of menstrual period 132 44.00 Both time 66 22.00 Interfering class attendance Yes 280 93.33 No 20 6.67 All daily activity affected and analgesics required Yes 262 87.33 No 38 12.67 Pain severity, associated symptom and consequences on daily activities of Undergraduate Female Medical Students, at Haramaya University, Ethiopia, 2023. In this study 60% (95% CI 55.86, 64.46) of undergraduate regular female medical students had primary dysmenorrhea, while only 40% (95%CI 35.54, 44.14) were free from primary dysmenorrhea (Fig.  3 ). Fig. 3 Prevalence of primary dysmenorrhea. Prevalence of primary dysmenorrhea. For this study, a binary logistic regression model was fitted. During bivariable analysis, 16 variables with p  < 0.25 were included in multivariable analysis. Accordingly, age, department, body mass index, history of depression, history of social disruption, studying area stress, family history of dysmenorrhea, type of menstruation, coffee consumption, Coca-Cola consumption, chocolate consumption, studying of bulky subject, unsecured living dormitory, long period of studying, tightly controlled schedule and sleepless night duty. Only four variables, including family history of dysmenorrhea, type of menstruation, studying area stress and coffee consumption per day, showed significant association with primary dysmenorrhea at p  < 0.05. The odds of primary dysmenorrhea were 2.57 (AOR = 2.57, 95% CI 1.67, 3.95) times more likely among female medical students who had family history of dysmenorrhea when compared with those who did not have family history of dysmenorrhea. Similarly, primary dysmenorrhea was 1.7 (AOR = 1.70, 95% CI 1.14, 2.53) times more likely among female medical students with irregular types of menstruation as compared with female medical students with regular types of menstruation. Additionally, undergraduate female medical students who had studying area stress were 2.39 (AOR = 2.39, 95% CI 1.11, 5.16) times more likely to develop primary dysmenorrhea when compared with those who had no studying area stress. Likewise, female medical students who consumed > 3 cups of coffee per day had a 3.25 (AOR = 3.25, 95% CI 1.32, 8.04) times higher chance to develop primary dysmenorrhea when compared with those who did not drink coffee at all. The association between high coffee intake and primary dysmenorrhea appears strong (AOR = 3.25), and the wide CI 1.32, 8.04 would suggest the result is statistically significant but imprecise (Table 4 ). Table 4 Bivariable and Multivariable analysis of Factors associated with primary dysmenorrhea among undergraduate female medical students at Haramaya University, Ethiopia, 2023. Variables Primary dysmenorrhea Crude odds ratio COR (95%CI) Adjusted odds ratio AOR (95%CI) P -value Yes (%) No (%) Age 19–24 244(81.33) 172(86.87) 1 1 25–30 56(18.67) 26( 13.13) 1.52(0.92,2.51) 1.31(0.75,2.28) 0.345 Departments of study Medicine 136(45.33) 78(39.39) 1 1 Medical lab 48(16.00) 44(22.22) 0.63(0.38,1.02) 0.65(0.36,1.17) 0.152 Pharmacy 77( 25.67) 55(27.78) 0.80(0.52,1.25) 0.96(0.57,1.62) 0.891 Health officer 39(13.00) 21(10.61) 1.07(0.58,1.94) 1.10(0.56,2.17) 0.775 Body mass index Underweight 8(2.67) 9(4.55) 1 1 Normal 217(72.33) 137(69.19) 1.78(0.67,4.73) 1.74(0.59,5.09) 0.313 Overweight 61(20.33) 42(21.21) 1.63(0.58,4.58) 1.46(0.47,5.54) 0.515 Obese 14(4.67) 10( 5.05) 1.57(0.45,5.50) 1.32(0.33,5.21) 0.694 History of depression Yes 147(49.00) 76(38.38) 1.54(1.07,2.22) 1.51(0.89,2.54) 0.126 No 153(51.00) 122(61.62) 1 1 History of social disruption Yes 94(31.33) 52(26.26) 1.28(0.86,1.91) 0.81(0.46,1.43) 0.471 No 206(68.67) 146(73.74) 1 1 Studying area stress Yes 226(75.33) 120(60.61) 1.98(1.35,2.92) 2.39(1.11,5.16) 0.026** No 74(24.67) 78(39.39) 1 1 Family history of dysmenorrhea Yes 145(48.33) 49(24.75) 2.84(1.92,4.21) 2.57(1.67,3.95) 0.000** No 155(51.67) 149(75.25) 1 1 Type of menstruation Regular 157(52.33) 130(65.66) 1 1 Irregular 143(47.67) 68(34.34) 1.74(1.20,2.52) 1.70(1.14,2.53) 0.010** Coffee consumption Not at all 80(26.67) 64(32.32) 1 1   3 cup/day 39(13.00) 8(4.04) 3.9(1.70,8.93) 3.25(1.32,8.04) 0.011** Coca-Cola or pepsi consumption Not at all 157(52.33) 85(42.93) 1 1 one per day 128(42.67) 107(54.04) 0.64(0.45,0.93) 0.66(0.42,1.04) 0.076  > 1/day 15(5.00) 6(3.03) 1.35(0.51,3.61) 0.94(0.28,3.11) 0.918 Chocolate consumption per day Not at all 136(45.33) 81(40.91) 1 1 2 bars pea day 136(45.33) 104(52.53) 0.78(0.54,1.13) 0.92(0.59,1.46) 0.742  > 2 bars/day 28(9.33) 13(6.57) 1.28(0.63,2.61) 1.15(0.48,2.75) 0.748 Studying of bulky subject No 131(43.67) 110(55.56) 1 1 Yes 169(56.33) 88(44.44) 1.61(1.12,2.31) 1.06(0.58,1.91) 0.853 Unsecured living dormitory No 157(52.33) 117(59.09) 1 1 Yes 143(47.67) 81(40.91) 1.32(0.92,1.89) 0.77(0.43,1.37) 0.381 Long period of studying No 131(43.67) 107(54.04) 1 1 Yes 169( 56.33) 91(45.96) 1.52(1.06,2.17) 0.96(0.52,1.75) 0.882 Tightly controlled schedule No 120(40.00) 100(50.51) 1 1 Yes 180(60.00) 98(49.49) 1.53(1.07,2.19) 0.60(0.32,1.13) 0.117 Sleepless night duty No 269(89.67) 184(92.93) 1 1 Yes 31(10.33) 14(7.07) 1.51(0.78,2.92) 1.07(0.51,2.24) 0.860 Yes * Statistically significant at P  < 0.05, 1: reference category. Bivariable and Multivariable analysis of Factors associated with primary dysmenorrhea among undergraduate female medical students at Haramaya University, Ethiopia, 2023. * Statistically significant at P  < 0.05, 1: reference category.

The finding of this study revealed the prevalence of primary dysmenorrhea among undergraduate female medical students, at Haramaya University were 60% (95% CI 55.86, 64.46), which is in line with studies done at Debre Tabor University 62.3% 23 and Haramaya University 64.7% 24 . However, the result of this study was lower than previous studies done at the University of Athens 89.2% 25 , the Spanish University of Castilla-La-Mancha 74.8% 26 , the Jouf University of Saudi Arabia 91.2% 27 , Romania 78.4% 28 , Beni-Suef University of Egypt 92.9% 29 and Tamale campus University at Ghana 83.6% 30 . The variation may be due to the study setting, study area, design, study population, and life style. Moreover, medical students may have higher stress than the general population due to intense academic pressure, very competitive environment and workload. In this study, we observed that undergraduate female medical students who had a family history of dysmenorrhea were 2.57 times more likely to develop primary dysmenorrhea. This result is comparable with finding from Spanish University 26 risk of primary dysmenorrhea among female student those who has family history of dysmenorrhea was 2.62 (AOR = 2.62; 95% CI 1.42, 4.82) greater than those without, study carried out at Taif University student, Saudi Arabia the most common risk factors for primary dysmenorrhea were family history( p  = 0.001) 31 , study done at University of China revealed maternal history of dysmenorrhea (AOR:2.5; 95% CI 2.24–2.9) were associated risk factors of primary dysmenorrhea 32 and study conducted at Northwest Ethiopia 33 reported, positive family history of dysmenorrhea (AOR = 5.19, 95% CI 3.21, 8.37) were significantly associated with primary dysmenorrhea. This may be due to genetic linkage between the mother and the daughter that makes them develop menstrual pain 34 . Having an irregular monthly menstrual cycle is the associated factor of primary dysmenorrhea. Female medical students who had irregular monthly menstrual cycles are 1.7 times more likely to develop primary dysmenorrhea compared to those having regular monthly menstrual cycle. This result was in line with result from study done at University of China 32 irregular menstrual cycle (AOR:1.23;95% CI 1.06–1.39) were associated factors of primary dysmenorrhea, study done at Tamale campus University at Ghana, showed irregular menstrual flow ( p  = 0.005) were significantly associated with dysmenorrhea 30 , study conducted in Ethiopia showed that irregular menstrual cycle (AOR:2.34;95% CI 1.55,3.54) had statistically significant association with dysmenorrhea 10 and study conducted at Northwest Ethiopia 33 reported, female students who had irregular monthly menstrual cycle is nearly two times more likely to develop primary dysmenorrhea compared to those having regular monthly menstrual cycle (AOR = 1.701,95% CI 1.02,2.84). This can be due to the hyperproduction of prostaglandins by the endometrium, which results in increased uterine contractions and arterial vasoconstriction, causing ischemic pain 10 . Among personal behaviors, coffee consumption is the only risk factor of primary dysmenorrhea. Undergraduate female medical students who consumed > 3 cups of coffee/day were 3.25 times likely to develop primary dysmenorrhea when compared with those who did not drink coffee at all. This finding was in agreement with findings from a study done in Kuwait that drinking coffee ( p -value = 0.004) was significantly associated with dysmenorrhea 35 and study done at Bezmialem Vakif University, Istanbul 4 drinking coffee ( P  = 0.001) was significantly associated with dysmenorrhea. This may be a result of caffeine, which is the main ingredient of coffee, is an adenosine analogue that inhibits adenosine (a potent vasodilator) receptors 36 . Blocking these receptors causes vasoconstriction that will decrease the blood flow to the uterus, causing further increase in the degree of menstrual pain. This study also found that having a history of studying area stress was found to have a significant association with the occurrence of primary dysmenorrhea, which is 2.39 times more likely when compared with those who had no studying area stress. This could be probably due to physiologically stress causing impairment in the development of the follicle that reduces the release of progesterone and increases the production of prostaglandin and causes pain 24 .

In this study, three out of every five female medical students of Haramaya University experienced primary dysmenorrhea . Factors such as family history of dysmenorrhea, irregular menstrual cycle, history of studying area stress and consuming > 3 cups of coffee/day were significantly associated with the occurrence of primary dysmenorrhea. We recommend Haramaya University to organize educational campaigns, stress management programs, and caffeine awareness initiatives in order to minimized risk factors. Limitation of the study is that unmeasured variables such as diet, physical activity, and sleep quality which could influence both the exposure and the outcome. These factors are biologically plausible confounders in the context of primary dysmenorrhea, as supported by prior research. Their omission may introduce residual confounding, potentially biasing the observed associations. Future studies should incorporate validated tools to measure these variables and assess their impact through multivariable modeling.

Menstruation is a normal physiological process that occurs approximately every month in women 1 . Primary dysmenorrhea (PD) is defined as menstrual pain without any identifiable apparent pelvic pathology that usually begins during adolescence. The condition arises from excessive production of prostaglandins at the time of ovulation, which leads to increased intrauterine pressure and abnormal uterine contractions. Additionally vasoconstriction of uterine vessels results in decreased blood flow, ischemia of the uterine muscles, and increased sensitivity of pain receptors, all of which cause pelvic pain 2 . Pain usually occur 2–4 days before or/and at the onset of menses and may last for 1–3 days 3 . In contrast, secondary dysmenorrhea refers to menstrual pain caused by underlying pelvic pathology, such as endometriosis, adenomyosis, intra uterine adhesions, cervical stenosis, ovarian cysts, uterine myoma or polyps, infertility problems and pelvic inflammatory disease 6 . Women affected by PD experience sharp, intermittent spasms of pain usually concentrated in the supra pubic area and radiating to the lower back or thighs. This pain is often accompanied by sweating, tachycardia, headache, nausea, vomiting, diarrhea, breast tenderness, and mood changes 4 , 5 . Furthermore, PD negatively affects multiple aspects of individual’s quality of life, affecting both behavioral and psychological well-being. Common consequences include mood disorders, sleep disturbances, and limitations on daily activities. Moreover, dysmenorrhea is associated with loss of concentration in class, increased school absenteeism, lack of active participation, reduced study time, poor exam performance, inability of doing homework and limited activity 5 , 7 , 8 . A 2024 systematic review and meta-analysis revealed that Psychological problems (59.9%), poor concentration (42.3%) and absenteeism from the class (41.3%) were the common impacts of dysmenorrhea 9 . PD is responsible for substantial financial losses that extend beyond the individual level to the future generations, due to impaired daily activities and decreased productivity. Among women who are affected by dysmenorrhea, about 15%–20% of them are unable to perform their normal daily activities during each menstrual period 10 . For instance, in the USA, an estimated 140 million working hours are lost annually due to primary dysmenorrhea. Additionally, in Japan, an estimated US$4.2 billion economic losses occur as a result of primary dysmenorrhea 11 . Studies done on dysmenorrheal patients that indicate changes brain structural and functional change which ultimately results in increased pain sensitivity, stress and anxiety, generally induced mental health disorders are one of most devastating sequel from dysmenorrhea 12 . Notably, dysmenorrhea often co-occurs with chronic pain conditions later in life, such as irritable bowel syndrome, painful bladder syndrome, fibromyalgia, chronic headache, chronic low back pain 13 . Globally, the prevalence of primary dysmenorrhea ranges from 16–91% to 10–20% of them suffer from severe dysmenorrhea 14 . The highest prevalence was reported from Egyptian university students, in which 93% of them had painful menstruation 15 followed by 91.5% of Ireland University students 16 . In Ethiopia, the overall prevalence of dysmenorrhea among University students was 71.69% 17 . Comparative research data indicates that medical students experience higher levels of perceived stress compared to the general population and students from other academic disciplines. Medical education is known for its rigorous curriculum and high-stress environment. Studies have shown that medical students experience elevated levels of perceived stress compared to the general population and students in other academic fields 18 . The major associated factors with dysmenorrhea are early age at menarche, family history of dysmenorrhea, premenstrual syndrome, anxiety, smoking, unmarried, caffeine consumption, and heavy menstruation 4 , 19 , 20 . Similarly, studies carried out in Ethiopia reported that tea consumption, usual use of fat and oil-containing food and usual use of meat food were significantly associated with dysmenorrhea 14 . Although there is a dearth of evidence particularly indicating primary dysmenorrhea having a high prevalence among medical students in the world, there is no information available regarding its prevalence and associated factors of among medical students in Ethiopia. Therefore, the primary purpose of our study is to provide insights into the prevalence and associated factors of primary dysmenorrhea among undergraduate regular female medical students of the College Health and Medical Science, Haramaya University, Harar, Ethiopia.