(41) Dysmenorrhea and Quality of Life in Early Adolescents: A Prospective Mobile Application Study

Background: Primary dysmenorrhea, menstrual pain occurring in the absence of pelvic pathology, typically starts in the first 3 years post-menarche as ovulatory cycles are established. Prior studies have generally been observational, cross-sectional, or retrospective leading to recall bias, and few have assessed the impact of dysmenorrhea in the early post-menarcheal years. The aim of this study was to prospectively characterize dysmenorrhea and global quality of life (QoL) during menses in early adolescents over 6-months.

Methods: A prospective, observational IRB approved study utilizing a multi-platform mobile application that allowed real-time assessment of menses was conducted. English speaking, post-menarcheal, biological female adolescents, aged 10-14 years, who had regular access to a smart device were enrolled from outpatient primary and specialty clinics. Participants could document the following during each menses: 1) pattern and flow of menses using the Pictorial Blood Loss Assessment Chart, 2) intensity, location, and duration of dysmenorrhea, and 3) QoL in 6 domains (family, friends, health, extracurriculars, school, job). Impact on job was minimal given age group assessed and thus was excluded. Descriptive analyses included medians (interquartile ranges) for continuous variables and counts (percentages) for categorical variables.

Results: 126 participants were included in analyses with a median age of 13.0 years, 79 (63%) were white, 56 (45%) overweight/obese, and gynecological age was < 3 years in 112 (89%). Among all participants, 506 menstrual cycles were documented with a median number of four cycles per participant. Median duration of menses and dysmenorrhea were 5.0 and 2.0 days, respectively. Dysmenorrhea was present in 375 (74%) of 506 cycles. Median pain intensity per cycle was 4 out of 10. In 275 (54%) of cycles, pain was reported in abdomen, 244 (48%) pelvis, 138 (27%) back, and 58 (11%) thighs. QoL was impacted in 232 (46%) cycles in any domain. Top three QoL domains impacted were health 142 (28%), extracurriculars 112 (22%), and school 90 (18%). Most prevalent concerns in these domains included: tiredness, headache, nausea, anxiety, poor concentration, leaking, and inability to use restroom. Family and friend domains were impacted in 82 (16%) and 50 (9.9%) cycles, respectively, with top concerns being over-reacting, fighting, or missing a family/friend event.

Conclusions: Prospective analysis of menses was feasible in early adolescents utilizing a mobile application. Among early post-menarcheal biological females, dysmenorrhea was present in most menstrual cycles, and some impact on QoL occurred in almost half of cycles.