Prevalence, severity and correlates of dysmenorrhea among postpartum women in Western Kenya: A cross-sectional study

Résumé

Dysmenorrhea is the most common menstrual disorder globally, contributing the highest disease burden of any gynecological issue in low- and middle-income countries (LMICs). Yet, limited data exist on dysmenorrhea among women in LMICs, particularly in Sub-Saharan Africa, including countries like Kenya. We conducted a cross-sectional analysis using data from the PrIMA-Extension Study, a large prospective cohort study that enrolled women during pregnancy and followed mother-child pairs up to 60 months post-delivery in four clinics in Western Kenya. At 24 months post-delivery, we assessed prevalence, severity, and correlates of dysmenorrhea using the Cox Menstrual Symptom Scale. Moderate-to-severe dysmenorrhea was defined as ≥1 symptom that was moderately to very severely bothersome. Poisson regression models identified correlates of moderate-to-severe dysmenorrhea. Among 277 women (median age: 27 years, IQR: 24-31), 24% (n = 67) had moderate-to-severe dysmenorrhea. Women predominantly reported cramps (46%), abdominal pain (34%), headaches (13%), weakness (8%), and dizziness (8%), lasting 3-7 hours or longer. Severe symptoms of dysmenorrhea most often reported were cramps (17%), abdominal pain (12%), headaches (4%), and weakness (3%). In a multivariate analysis adjusted for age and current breastfeeding status, moderate-to-severe dysmenorrhea was associated with high scores of adverse childhood experiences (ACEs; adjusted PR [aPR]=1.71, 95% CI: 1.04-2.79, p = 0.03), spending time in bed due to menstrual problems (aPR = 3.11, 95% CI: 1.88-5.14, p < 0.001), and taking painkillers (aPR = 4.12, 95% CI: 2.52-6.73, p < 0.001). Adjusting for age, current breastfeeding was associated with a higher frequency of moderate-to-severe dysmenorrhea (aPR = 1.66, 95% CI: 1.02-2.71, p = 0.04). At 2 years postpartum, nearly 1 in 4 women reported moderate-to-severe dysmenorrhea, associated with ACEs and resulting in daily functional interruptions. These findings underscore the need for routine menstrual health assessment during care and integrated approaches addressing pain management and psychosocial support.

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