The severity and correlates of dysmenorrhea among women in Western Kenya

Abstract

Dysmenorrhea is the most common menstrual disorder, bearing the highest disease burden of any gynecological issue in low- and middle-income countries. There is a lack of data on the frequency, severity, and correlates of dysmenorrhea among women in Kenya. This thesis utilized cross-sectional data from the n=277 women enrolled in the PrIMA-X study in Western Kenya to assess the prevalence, severity, and correlates of dysmenorrhea. Dysmenorrhea symptoms were evaluated using the Cox Menstrual Symptom Scale (CMSS). Dysmenorrhea was defined as reporting at least one symptom that was moderately to very severely bothersome and lasted for at least one full day. Poisson regression models identified the correlates of severe dysmenorrhea. The median age of participants was 27 years (IQR: 24–31). Overall, 8% (n=23) of women met the criteria for severe dysmenorrhea. Based on symptom duration, women predominantly reported cramps (46%), abdominal pain (34%), headaches (13%), weakness (8%), and dizziness (8%). In terms of severity, the most frequently reported symptoms were cramps (17%), abdominal pain (12%), headaches (4%), and weakness (3%). In a multivariate analysis adjusted for age, current breastfeeding status was associated with a higher frequency of severe dysmenorrhea (adjusted RR [aRR]=1.66, 95% CI: 1.02–2.71, p=0.04). Additionally, after controlling for age and current breastfeeding status, correlates of severe dysmenorrhea included high adverse childhood experiences (aRR=1.71, 95% CI: 1.04–2.79, p=0.03), spending any time in bed due to menstrual problems (aRR=3.11, 95% CI: 1.88–5.14, p<0.001), and taking painkillers for menstrual relief (aRR=4.12, 95% CI: 2.52–6.73, p<0.001). This study provides evidence on the burden and risk factors of dysmenorrhea among women who gave birth in Kenya and underscores the need for targeted interventions, such as routine menstrual health assessment during postpartum care and integrated approaches addressing both pain management and psychosocial support.