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Primary dysmenorrhea and its associated factors
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Introdução: A dismenorreia primária é uma das patologias ginecológicas mais comuns em mulheres em idade fértil, com uma prevalência de 40% a 90%. Apesar do grande impacto que tem na vida destas mulheres, a sua etiologia ainda não está totalmente esclarecida. Esta revisão narrativa tem como objetivo descobrir que fatores de risco estão associados a esta patologia, para direcionar novos estudos que melhor esclareçam a sua etiologia. Métodos: Foi feita uma pesquisa literária usando as bases de dados eletrónicas PubMed, Google Scholar e Cochrane Library. Foram selecionados estudos epidemiológicos, experimentais e transversais, dando preferência aos relativos à dismenorreia primária e não incluídos ainda em revisões anteriores. Foram também incluídos estudos sobre dismenorreia geral. Os resultados foram analisados e comparados entre cada estudo, tal como os métodos e critérios usados para cada variável. Resultados: Relativamente a fatores não modificáveis, história familiar de dismenorreia primária, menstruações abundantes e ciclos curtos ou irregulares parecem estar associados à dismenorreia primária. A idade e idade da menarca obtiveram resultados variáveis, apesar de potencialmente associadas também. Entre os fatores modificáveis, apenas saltar refeições e um índice de massa corporal baixo foram associados diretamente com a dismenorreia primária, enquanto um maior consumo de água e uso de contracetivos hormonais demonstraram ter um efeito protetor. Conclusão: Os resultados desta revisão apontam para uma patogénese multifatorial. Os fatores de risco associados à dismenorreia primária sugerem um maior crescimento endometrial, o que poderá ser explicado por alterações hormonais. São necessários mais estudos nesta área e com critérios mais bem definidos, para melhor entender a etiologia desta patologia. Devem também ser estudados outros fatores como anemia e desidratação, que possivelmente agravarão a isquémia endometrial, atualmente considerada como a causa mais provável da dor experienciada na dismenorreia primária.
Background: Primary dysmenorrhea (PD) is one of the most common gynaecological pathologies in women of reproductive age, with a prevalence of 40 to 90%. Despite its impact in the lives of these women, its aetiology is still not fully understood. This narrative review aims to find which risk factors are associated with PD, to potentially direct further studies to better understand its aetiology. Methods: Research was made using the electronic databases PubMed, Google Scholar and Cochrane Library to find relevant studies about factors associated with primary dysmenorrhea. A selection was made of epidemiological, cross-sectional and experimental studies, with a preference for studies regarding PD and not included in previous reviews. Studies on general dysmenorrhea were also included. Results were analysed and compared between the studies, as well as the methods and criteria used for each variable. Results: Regarding non-modifiable factors, family history of primary dysmenorrhea, heavy menstrual flow and short or irregular cycles seem to be correlated with PD. Age and age at menarche showed mixed results, although there could be a possible association. Among modifiable factors, only skipping meals and a low body mass index were found to be directly correlated with PD, while a higher water intake and use of hormonal contraceptives were inversely associated with the pathology. Conclusion: The results of this review point to a multifactorial pathogenesis of primary dysmenorrhea. The risk factors associated with PD suggest a larger endometrial growth, that could be explained by hormonal changes. More studies, with better defined criteria, are needed in this area, to better understand the aetiology of PD. Other factors that could potentially aggravate endometrial ischemia, currently accepted as the most probable cause of pain experienced in primary dysmenorrhea should also be studied, such as anaemia and dehydration.
Background: Primary dysmenorrhea (PD) is one of the most common gynaecological pathologies in women of reproductive age, with a prevalence of 40 to 90%. Despite its impact in the lives of these women, its aetiology is still not fully understood. This narrative review aims to find which risk factors are associated with PD, to potentially direct further studies to better understand its aetiology. Methods: Research was made using the electronic databases PubMed, Google Scholar and Cochrane Library to find relevant studies about factors associated with primary dysmenorrhea. A selection was made of epidemiological, cross-sectional and experimental studies, with a preference for studies regarding PD and not included in previous reviews. Studies on general dysmenorrhea were also included. Results were analysed and compared between the studies, as well as the methods and criteria used for each variable. Results: Regarding non-modifiable factors, family history of primary dysmenorrhea, heavy menstrual flow and short or irregular cycles seem to be correlated with PD. Age and age at menarche showed mixed results, although there could be a possible association. Among modifiable factors, only skipping meals and a low body mass index were found to be directly correlated with PD, while a higher water intake and use of hormonal contraceptives were inversely associated with the pathology. Conclusion: The results of this review point to a multifactorial pathogenesis of primary dysmenorrhea. The risk factors associated with PD suggest a larger endometrial growth, that could be explained by hormonal changes. More studies, with better defined criteria, are needed in this area, to better understand the aetiology of PD. Other factors that could potentially aggravate endometrial ischemia, currently accepted as the most probable cause of pain experienced in primary dysmenorrhea should also be studied, such as anaemia and dehydration.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Dismenorreia primária Dismenorreia Menstruação Endométrio Factores de risco Dor