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

Mohammed Sobh Abdulkhaliq; Mashael Abdullah Alshahrani; Ghadi Mohammad A Alamri; Reema Mohammed  Aldawodi; Halah Ahmad  Memish; Sohaila Ahmed  Asiri; Arwa Awad Alqahtani; Maram Ali M  Ashahrani; Razan H.   AlQahtani; Yusra Hasan Alrimthi; Saeed Ali M   Alzahrani; Zarah Qasem  Jaber

doi:10.54293/smhj.v6i1.185

Authors

Mohammed Sobh Abdulkhaliq Obstetrics and gynecology consultant Abha Maternity and children hospital Abha , KSA.
Mashael Abdullah Alshahrani Medical intern, College of Medicine, King Khalid University, Abha , KSA.
Ghadi Mohammad A Alamri Medical intern, college of Medicine ‏ King Khalid University, Abha, KSA. https://orcid.org/0009-0004-8055-9564
Reema Mohammed Aldawodi Medical intern, College of Medicine, King Khalid University, Abha , KSA.
Halah Ahmad Memish Medical intern, College of Medicine, King Khalid University, Abha , KSA.
Sohaila Ahmed Asiri College of Medicine, King Khalid University, KSA. https://orcid.org/0009-0000-5983-5887
Arwa Awad Alqahtani Medical intern, College of Medicine, King Khalid University, Abha , KSA.
Maram Ali M Ashahrani Medical intern, College of Medicine, King Khalid University, Abha , KSA.
Razan H. AlQahtani Medical intern, College of Medicine, King Khalid University, Abha , KSA.
Yusra Hasan Alrimthi Medical intern, College of Medicine, King Khalid University, Abha , KSA. https://orcid.org/0009-0009-1475-0359
Saeed Ali M Alzahrani General practitioner , Albaha King Fahad Hospital, KSA.
Zarah Qasem Jaber Nurse Specialist , Abha maternity and children hospital, Abha, KSA.

DOI:

https://doi.org/10.54293/smhj.v6i1.185

Keywords:

Primary dysmenorrhea, Stress, Anxiety, Pain severity, Psychological distress, HPA axis, 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.