Subhadra Evans, Associate Professor, Psychology, Deakin University, Antonina Mikocka-Walus, Professor in Health Psychology, Deakin University, Marilla L. Druitt, Affiliate Senior Lecturer, Faculty of Health, Deakin University
Around half of teenage girls experience moderate to severe period pain. The mechanical force of the uterus contracting and inflammatory chemicals such as prostaglandins contribute to this pain.
Moderate to severe period pain has a significant impact on daily life. Girls with period pain are three to five times more likely than their peers to miss school or university, and two to five times more likely to miss out on social and physical activities.
Our new research found girls with period pain reported higher levels of psychological distress as young adults, even after accounting for earlier mental health issues and socioeconomic factors.
What comes first?
Menstrual pain has been dismissed and under-treated. Women report there is a perception among some health-care providers that stress, anxiety, or depression cause their pain.
However, participants in our lived experience research have told us that period pain leads to psychological distress. As one woman explained:
mental health [is] used frequently by health professionals to diminish my symptoms and make me feel as though I have untreated mental health conditions that are the cause of my issues instead of my physical pain.
Prior research suggests a bi-directional link between pain and mental health. A study of almost 15,00 adolescents with chronic pain found an increased risk of lifetime anxiety and depression. While our prior research on pelvic pain in adults showed psychological distress can worsen functional pain over time.
Research exploring the relationship between mental health and pain in teens with period pain is limited, with the direction of the relationship still unclear.
Take the example of Ruby, who represents a composite of clinical cases:
Ruby was netball captain in Year 6 but painful periods led to her dropping out of the team in Year 8. By Year 10, she was socialising less with her friends. At 17, she felt like her mental health was deteriorating and was locked in a struggle with her own body. Ruby saw her GP and was told to take Nurofen and keep moving because anxiety and depression had caused chronic pain.
While research has linked mental health and pain perception, we set out to determine the direction of this link: do mental health difficulties lead to period pain? Or does period pain contribute to mental health issues?
Our new study
We used data from the Longitudinal Study of Australian Children, also known as Growing Up in Australia, which has tracked the lives of 10,000 children and their families since 2004. We used data that tracked 1,600 girls who reported on their periods from age 14, 16 and 18.
Parents reported symptoms of anxiety and depression when the girls were 14–16 years old. The young women self-reported these symptoms at age 18, and levels of psychological distress at age 20–21.
This multi-stage study allowed us to look at how menstrual pain and mental health show up together and change over time during an important stage in young women’s lives.
While conditions such as endometriosis (which causes tissue similar to that which lines the uterus to grow outside the uterus) can be associated with pelvic pain, including period pain, the survey didn’t ask participants about endometriosis or pain-related diagnoses. So this didn’t form part of our study.
Around half of the participants experienced moderate to severe period pain.
We found girls who had painful periods were much more likely to also have symptoms of anxiety and depression at ages 14, 16 and 18 compared to those who did not have painful periods.
At age 14, adolescents who experienced painful periods were around twice as likely to have symptoms of anxiety and depression, compared to their peers who said their periods were not painful, or only a little painful.
These adolescents also reported higher levels of psychological distress as young adults, even after accounting for earlier mental health issues and socioeconomic factors.
Adolescents who reported period pain throughout their teens were more likely to experience “moderate” psychological distress in early adulthood. In contrast, adolescents who did not have period pain were more likely to experience “mild” psychological distress in early adulthood.
Importantly, we showed that period pain often comes before mental health issues develop – not the other way around. This suggests period pain could be a risk factor for future mental health problems.
The findings underscore the importance of identifying adolescents who are experiencing period pain. Many adolescents believe period pain is something they just have to put up with, and don’t seek help.
What can be done about period pain?
We recommend treating period pain early with a variety of options.
First-line period pain management includes:
- anti-inflammatories such as ibuprofen, which are available over the counter
- seeing your GP to discuss hormonal therapies, such as the oral contraceptive pill.
Additional strategies to manage period pain can include:
Improved menstrual education is needed to ensure teens can recognise when their menstrual experience is unusual, and know where they can access support.
Some programs provide menstrual education across schools and community groups. This education should be extended to families and school health and wellbeing support staff to facilitate early recognition and intervention.
Finally, further research is needed to confirm whether addressing period pain promptly reduces the risk of longer-term mental health symptoms.
Subhadra Evans receives funding from the Australian Government.
Antonina Mikocka-Walus receives funding from the National Health and Medical Research Council.
Marilla L. Druitt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
