Psychosocial Predictors of Dysmenorrhea Stability and Change: A Two-Year Longitudinal Study

OBJECTIVES: This study aimed to identify menstrual pain trajectories over 2 years in young women with moderate-to-severe intensity, and determine baseline factors, including modifiable variables, that differentiate these trajectories. METHODS: This secondary analysis of a prospective cohort study included 157 women aged 18-45 years, enriched for moderate-to-severe menstrual pain. Pain during periods (without/before analgesic use) was reported at 3 visits: baseline, Year 1 and Year 2. Baseline measures included non-menstrual pelvic pain (NMPP), anxiety, depression, pain catastrophizing, somatic sensitivity, and sleep disturbance. Hormonal contraceptive use, pregnancies, and menstrual suppression were tracked annually. We performed growth mixture modelling to identify pain trajectories. RESULTS: Four trajectories emerged: high-stable pain (63%), low-stable pain (15%), improving pain (11%), and worsening pain (11%). High-stable pain was characterized by higher baseline NMPP, somatic sensitivity, and sleep disturbance compared with low-stable pain. The improving group had greater hormonal contraceptive use at follow-up (primarily combined oral contraceptives; regimen patterns inconsistently reported) compared with the high-stable group. No predictors of the worsening trajectory group were identified. Very few pregnancies occurred over the follow-up period. CONCLUSIONS: Most menstrual pain trajectories remained stable over 2 years. Because women in the high-stable group demonstrated a broader burden of symptoms-NMPP, somatic sensitivity, and sleep disturbance-future studies should focus on multidisciplinary approaches, such as sleep optimization, complementing traditional use of non-steroidal anti-inflammatories. Future work is also needed to understand how pregnancy and tolerance of hormonal therapy may influence adverse symptom trajectories.