The Impact of Stress and Anxiety on Dysmenorrhea Severity: A systematic review

Abstract

Primary dysmenorrhea (PD) affects a significant proportion of menstruating individuals, with stress and anxiety increasingly recognized as modifiable factors influencing pain severity. This systematic review synthesizes evidence on the relationship between stress/anxiety and dysmenorrhea severity, exploring underlying mechanisms and clinical implications. Following PRISMA guidelines, we conducted a comprehensive search across PubMed, Web of Science, Scopus, and ScienceDirect. Included studies assessed stress (perceived stress, PTSD, occupational stress) or anxiety (generalized/trait anxiety) in individuals with PD, using validated scales. Risk of bias was evaluated using the Newcastle-Ottawa Scale and Cochrane RoB 2.0. Of 2,305 screened records, 45 studies met inclusion criteria, with 13 analyzed in detail. Cross-sectional studies (n=12) predominated, alongside one RCT study. Significant associations between stress/anxiety and PD severity (e.g., OR=2.8 for perceived stress (95% CI: 1.9–4.1); r=0.782, p<0.001 for stress-pain correlation). PTSD and occupational stress exacerbated dysmenorrhea (β=10.48, p=0.001; p <0.05, respectively). Neurobiological mechanisms (e.g., amygdala hypertrophy, HPA axis dysfunction) were implicated in pain amplification. Stress and anxiety are significantly associated with dysmenorrhea severity, potentially mediated by neuroendocrine and inflammatory mechanisms.

Affiliated Institutions

• Maternity and Children's Hospital SA
• King Khalid University SA
• King Fahad Hospital Jeddah SA

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