From Pain to Impairment: A Study of the Prevalence, Severity, and Impact of Dysmenorrhea in Women From the Eastern Region of Saudi Arabia

Abstract

Background:

Dysmenorrhea is a common condition that affects many women during their reproductive years and can lead to significant disruptions in daily life. While studied extensively worldwide, only limited research has been conducted on the severity and effects of dysmenorrhea in women from the Eastern region of Saudi Arabia. Therefore, this study aimed to examine the prevalence of dysmenorrhea and its impact on women from this region, using the Work ability, Location, Intensity, Duration of Dysmenorrhea (WaLIDD) score to assess the severity of dysmenorrhea across multiple dimensions.

Methods:

A cross-sectional study was conducted at the University of Hafr Al Batin to determine the severity of dysmenorrhea among 291 female students using the WaLIDD score. Data on demographic characteristics, clinical history, and menstrual patterns were collected through an online questionnaire. Statistical analyses, including Fisher’s exact test and ANOVA test, were performed using R Studio.

Results:

Among the participants, 13.1% had no or mild dysmenorrhea (no-to-mild), 47.4% had moderate dysmenorrhea, and 39.5% had severe dysmenorrhea. Severe dysmenorrhea was associated with significantly higher body mass index (BMI) (p = 0.024), a history of gynecological disease (p = 0.029), and seeking medical consultation (p < 0.001). Severe dysmenorrhea was also significantly associated with irregular cycles (p = 0.003), heavier menstrual flow (p < 0.001), and functional impairment (p < 0.001).

Conclusions:

Dysmenorrhea is highly prevalent and has significant effects on the daily life of young women in the Eastern region of Saudi Arabia. BMI and menstrual characteristics play key roles in the severity of dysmenorrhea, thereby highlighting the need for targeted interventions and increased awareness to improve management strategies.

Graphical abstract

Keywords

dysmenorrhea / menstruation / menstrual health / pain / cross-sectional studies

1. Introduction

Dysmenorrhea is a prevalent gynecological condition characterized by painful uterine contractions that lead to recurrent pelvic pain, particularly among adolescents and young adult women. It is generally categorized into two subtypes: primary dysmenorrhea, which occurs without identifiable pelvic pathology and typically responds well to analgesic therapy, and secondary dysmenorrhea, which is often more severe and associated with underlying conditions such as endometriosis or uterine fibroids [1, 2, 3].

Globally, dysmenorrhea affects between 50% and 90% of menstruating women [4, 5, 6, 7, 8]. In Saudi Arabia, the burden appears to be particularly high, with a reported prevalence ranging from 70% to 92.3% [9, 10, 11, 12, 13, 14, 15]. This condition has been found to significantly disrupt daily activities, academic performance, and overall quality of life [16]. While numerous international and national studies have examined its prevalence, variations in study design and data collection tools, particularly the inconsistent use of systems for grading severity, have contributed to heterogeneity in the reported outcomes. In many cases, emphasis has been placed on estimating the prevalence of dysmenorrhea, with less attention given to the standardized assessment of symptom intensity and functional effects, thus making it difficult to examine potential associations with clinical and demographic factors [11, 15].

To address these limitations, the Work ability, Location, Intensity, Duration of Dysmenorrhea (WaLIDD) score developed by Teherán et al. (2018) [17] provides a validated and multidimensional approach for grading the severity of dysmenorrhea in the range from none to severe. This tool allows for more objective assessments and consistent comparisons across populations, while including factors such as body mass index (BMI) and menstrual characteristics in the analysis. Previous studies have suggested an association between higher BMI and increased severity of dysmenorrhea, as well as a strong relation between symptom severity and reduced quality of life [18, 19, 20, 21].

Only a limited number of studies conducted in Saudi Arabia have used the WaLIDD score to assess dysmenorrhea. Notably, Alateeq et al. (2022) [12] examined its association with depression, while Almanasef and Alqarni (2023) [15] investigated self-management strategies. While both studies provide valuable contributions, neither focused on the relationship between the severity of dysmenorrhea and clinical or menstrual characteristics. The goal of the present study was to fill that gap by assessing the prevalence, severity, and functional effects of dysmenorrhea among female university students in Hafr Al Batin, Eastern Saudi Arabia, using the WaLIDD score. We also investigated associations between the severity of dysmenorrhea and key variables such as age, BMI, and menstrual characteristics. By using a standardized and validated tool, this research has the potential to enhance clinical understanding, support targeted interventions, and promote greater awareness of menstrual health among young women.

2. Materials and Methods

2.1 Study Design and Setting

A total of 300 Saudi women were recruited from the University of Hafr Al Batin (Hafr Al Batin, Saudi Arabia) between May 2023 and November 2024. The study used convenience sampling, and the sample size was determined using G*Power software (version 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) to achieve a 95% CI (\alpha = 0.05) and 80% statistical power. The initial estimated sample size was 128, but this was increased to 300 to account for potential dropouts and missing data.

2.2 Data Collection

The participants were recruited through study flyers and brochures containing quick response (QR) codes that directed them to an online survey hosted on Google Forms. The survey was available in Arabic and collected information on demographic characteristics, socioeconomic status, and menstrual history. To ensure appropriate participant selection, specific inclusion and exclusion criteria were applied as follows:

Inclusion Criteria:

Saudi women.

Aged 17 years or older.

Enrolled as students at the University of Hafr Al Batin.

Exclusion Criteria:

Known pelvic disorders, including endometriosis, pelvic inflammatory disease, and uterine fibroids.

History of pelvic surgery.

Pregnancy.

2.3 Statistical Analysis

The severity of dysmenorrhea was assessed using the WaLIDD score. This was calculated by assigning numeric values to participant responses across four domains related to menstrual pain: pain intensity, location of pain, interference with work or school, and duration of pain. Each component was scored on a 4-point scale from 0 to 3. Pain intensity was categorized using a modified Wong-Baker scale, where “Does not hurt” was scored as 0, “Hurts a little bit” as 1, “Moderate” and “Severe pain” as 2, and “Very severe” and “Intense pain” as 3. Pain location was scored based on the number of body parts affected, with “None” as 0, “One site” as 1, “2–3 sites” as 2, and “4 sites” as 3. Interference with daily activities was rated from “None” (0) to “Always” (3), reflecting increasing disruption of work or school. Duration of pain was classified by the number of days, with 0 days scored as 0, “1–2” days as 1, “3–4” days as 2, and more than 4 days as 3. The total WaLIDD score ranged from 0 to 12, and was further categorized into severity levels: 0–4 as no to mild dysmenorrhea (no-to-mild), 5–7 as moderate, and 8–12 as severe.

Demographic and clinical data were collected from participants, including information related to the severity of dysmenorrhea based upon the WaLIDD score. Categorical variables were described using frequencies and percentages. Categorical variables were compared between groups using the Chi-square test when the expected frequency in each cell was greater than 5, and Fisher’s exact test was applied when expected frequencies were \le5, and the Shapiro-Wilk test to test for normality. Variables that were normally distributed were presented as the mean and SD, while non-normally distributed variables were reported as the median and interquartile range (IQR). All variables included in our study were normally distributed. Continuous variables were analyzed using ANOVA, followed by Tukey’s post hoc test to compare differences between groups. Statistical significance was set at p 0.05, and all analyses were conducted using R Studio (version 4.3.1; R Foundation for Statistical Computing, Vienna, Austria). A multivariable regression model was constructed to assess the association of BMI with the outcome, after adjusting for age and history of gynecological disease.

3. Results

3.1 Demographic and Clinical Characteristics of Participants

A total of 291 participants were included in the study, of which 38 (13.1%) were classified as having no to mild dysmenorrhea, 138 (47.4%) with moderate dysmenorrhea, and 115 (39.5%) with severe dysmenorrhea (Fig. 1A). No significant differences in menstrual status, age distribution, marital status, or academic level were observed between the dysmenorrhea severity groups (all p > 0.05). However, significant differences between the groups were observed for BMI (p = 0.024), weight (p = 0.009), history of gynecological disease (p = 0.029), and consultation with a doctor for menstrual pain (p 0.001). Participants with moderate and severe dysmenorrhea had a higher BMI and were more likely to have a history of gynecological disease (Fig. 1B). In addition, a significantly greater proportion of those with severe dysmenorrhea had sought medical consultation for menstrual pain compared to those with milder symptoms (Table 1). Post hoc comparisons (Supplementary Table 1) revealed that participants in the moderate dysmenorrhea group had significantly higher weight and BMI compared to those in the no-to-mild dysmenorrhea group (mean weight difference = 8.36 kg, p = 0.008; mean BMI difference = 2.73 kg/m², p = 0.029). No significant differences in weight or BMI were observed between the moderate and severe groups, or between the no-to-mild and severe groups (p > 0.05). Multivariable regression analysis adjusted for age and history of gynecological disease revealed that a higher BMI was independently associated with outcome [odds ratio (OR): 1.11; 95% CI: 1.01–1.22; p = 0.04] (Supplementary Table 2).

3.2 Menstrual Cycle Patterns and Associated Symptoms

Menstrual characteristics varied significantly across the three dysmenorrhea severity groups. Participants with severe dysmenorrhea were significantly more likely to have experienced irregular menstrual cycles over the past 12 months compared to the no-to-mild dysmenorrhea group (47.0% vs. 23.7%, respectively, p = 0.003). The duration of menstrual cycles also differed significantly, with 14.8% of individuals with severe dysmenorrhea reporting cycles lasting 8 or more days, compared to just 2.2% in the moderate dysmenorrhea group and 10.5% in the no-to-mild group (p = 0.002). Menstrual bleeding patterns also showed significant differences. Heavy menstrual flow (more than four pads per day and/or associated with clots) was reported by 29.6% of women with severe dysmenorrhea compared to 11.6% in the moderate group and only 2.6% in the no-to-mild group (p 0.001). Conversely, normal menstrual flow was more common in women with milder symptoms, with 86.8% of the no-to-mild group reporting normal flow compared to 60.9% in the severe group. A positive family history of dysmenorrhea was significantly associated with severe dysmenorrhea, with 31.3% of women in the severe group reporting a family history compared to 21.1% in the no-to-mild group (p = 0.036) (Table 2).

Menstrual pain characteristics varied significantly between the dysmenorrhea severity groups. The prevalence of menstrual pain during the last three cycles was significantly higher in women with severe dysmenorrhea (93.9%) compared to the moderate group (74.6%) and the no-to-mild group (31.6%) (p 0.001). Similarly, pain frequency was significantly associated with the severity of dysmenorrhea, as 70.4% of women with severe dysmenorrhea reported experiencing pain during every menstrual cycle compared to 26.8% in the moderate group and only 7.9% in the no-to-mild group (p 0.001). The timing of menstrual pain also showed significant differences between the dysmenorrhea severity groups (p 0.001). Among participants with severe dysmenorrhea, 46.1% experienced pain both before and during menstruation, while a smaller proportion (25.2%) reported pain only during menstruation. In contrast, 42.1% of women reporting no-to-mild dysmenorrhea experienced pain only before menstruation, thus highlighting a distinct pattern of pain onset. Pain location was significantly associated with the severity of dysmenorrhea (p 0.001). While 55.7% of participants with severe dysmenorrhea experienced pain in the lower back, lower abdomen and thigh, only 26.1% of those in the moderate group and 7.9% in the no-to-mild group reported a similar pain distribution. Conversely, 18.4% of women with no-to-mild dysmenorrhea reported no pain at all, whereas none of the participants in the moderate or severe groups were pain-free (Table 3).

3.3 Assessment of Menstrual Pain Severity

The WaLIDD score components showed significant differences between the dysmenorrhea severity groups. First, the severity of menstrual pain was strongly associated with dysmenorrhea severity (p 0.001). Among participants with severe dysmenorrhea, 35.7% reported severe pain, 26.1% experienced very severe pain, and 22.6% reported intense pain. In contrast, 55.3% of participants with no-to-mild dysmenorrhea reported only slight pain, while 21.1% experienced no pain at all. Second, the pain distribution differed significantly between groups (p 0.001). While 30.4% of participants with severe dysmenorrhea experienced pain at four different body sites, only 1.4% in the moderate group and none in the no-to-mild group reported such widespread pain. Conversely, 26.3% of the no-to-mild group experienced no pain, whereas none in the severe group were pain-free. Third, the effect of menstrual pain on school attendance was significantly associated with dysmenorrhea severity (p 0.001). Over half the participants with severe dysmenorrhea (62.6%) reported that menstrual pain nearly always prevented them from attending school, while 27.8% reported they were always unable to attend school during menstruation. In contrast, 73.7% of participants in the no-to-mild group experienced no absenteeism. Finally, the duration of menstrual pain also varied significantly across groups (p 0.001). Among participants with severe dysmenorrhea, 37.4% reported their pain lasted for 3 to 4 days, while 26.1% experienced pain for more than four days. In comparison, 28.9% of the no-to-mild group reported they experienced no menstrual pain, and 68.4% reported their pain lasted only 1 to 2 days (Table 4).

3.4 Dysmenorrhea and Quality of Life (Impact on Daily Life)

Menstrual pain significantly affected the daily activities of participants, with the severity of dysmenorrhea correlating strongly with functional limitations (p 0.001). Among the participants with severe dysmenorrhea, 41.7% reported that pain completely prevented them from performing daily tasks, while 50.4% reported moderate interference. In contrast, 39.5% of the no-to-mild group reported no effect on their daily activities, and 47.4% experienced only slight interference.

Overall, 97.4% of participants with severe dysmenorrhea reported that menstrual pain affected their daily activities, compared to 83.3% in the moderate group and only 47.4% in the no-to-mild group (p 0.001). Similarly, menstrual pain had a significant effect on academic attendance (p 0.001). Over half the participants (75.9%) with severe dysmenorrhea reported missing 1 to 3 lectures because of pain, while 2.7% missed more than five lectures. Conversely, 78.4% of participants in the no-to-mild group reported never missing a lecture, compared to 47.4% in the moderate group and only 16.1% in the severe group (Table 5).

4. Discussion

This study offers important insights into the prevalence, severity, and functional effects of dysmenorrhea on female university students in Hafr Al Batin. It represents the first investigation of dysmenorrhea in this particular region of Saudi Arabia. Our findings are consistent with global trends, which underscore the high prevalence of dysmenorrhea and its significant impacts on women’s health and well-being. Dysmenorrhea, particularly primary dysmenorrhea, is a common condition that affects a substantial proportion of women worldwide, with estimates ranging from 50% to over 90% [7, 22]. The prevalence in Saudi Arabia is similarly high, as demonstrated by Bakhsh et al. (2022) [10] who conducted the largest study to date on 1199 women of reproductive age and reported a dysmenorrhea prevalence of 92.3%.

In our cohort, 39.5% of participants reported experiencing severe dysmenorrhea, which is comparable to the findings of several international studies [7, 22]. This high prevalence underscores the significant burden of dysmenorrhea on young women in this region, and is consistent with other studies that have reported high rates of menstrual pain, particularly among university students [23, 24]. It is notable that the severity of dysmenorrhea in the present study was significantly associated with a higher BMI, a history of gynecological disease, and a greater likelihood of seeking medical consultation. Our results are consistent with those of previous studies that have linked these factors to more severe menstrual pain [20, 25]. The observed odds ratio of 1.11 indicates that each unit increase in BMI is associated with an approximately 11% higher likelihood of experiencing more severe dysmenorrhea. Although modest on an individual level, this effect becomes clinically meaningful at the population level, especially in regions where overweight and obesity are prevalent. These findings suggest that weight management interventions, including lifestyle modifications such as diet and physical activity, could play a role in alleviating the severity of dysmenorrhea. Incorporating BMI assessment into routine gynecological care may therefore provide an opportunity for early counseling and targeted interventions to improve menstrual health outcomes.

The prevalence of dysmenorrhea observed in Saudi Arabia is notably higher than that reported in many other countries. The results from Saudi studies are consistently higher, with the reported incidence ranging from about 70% to 90% [10, 13]. In contrast, a much lower prevalence of dysmenorrhea has been reported in some countries. For example, studies from China and Iran have reported rates as low as 41% [26, 27], whereas in parts of Europe they approach 90% [28, 29]. Several factors might account for the elevated rates and burdens seen in Saudi women. One important consideration is population demographics. Many of the participants were young and nulliparous, an age group known to have more frequent and severe dysmenorrhea, which typically diminishes with older age and childbirth [30]. Cultural and healthcare-related factors could further exacerbate the problem. Limited awareness or stigma surrounding menstruation and the lack of sex education might prevent Saudi women from seeking effective management, thereby increasing the reported intensity and impact of symptoms. Up to 87% of Saudi women consistently report menstruation-related interference in daily activities, which is far above the ~38% of women globally who experience such a severe impact [9]. These considerations suggest that sociocultural factors contribute to the comparatively high prevalence of dysmenorrhea and the associated burden observed in Saudi Arabia. To mitigate this, universities could integrate menstrual health workshops into orientation programs, while policymakers should consider pilot revisions of school curricula to improve early health literacy. Additionally, variations in how dysmenorrhea is defined and measured, including the lack of standardized diagnostic criteria and differences in study populations, complicate cross-study comparisons and likely contribute to the wide range in reported prevalence.

Menstrual characteristics, including irregular cycles and heavier menstrual flow, were also strongly associated with the severity of dysmenorrhea in this study. Participants with severe dysmenorrhea were significantly more likely to report irregular cycles and heavy menstrual flow, which are established risk factors for stronger pain intensity [5, 31]. Moreover, our results revealed that menstrual pain significantly interfered with daily activities, including academic attendance. This is consistent with previous studies that reported adverse effects of dysmenorrhea on education and work performance [23, 32].

The significant relation between dysmenorrhea and diminished quality of life noted in our study is a major concern. Severe dysmenorrhea was found to affect the ability of participants to engage in daily tasks. Some degree of impairment was reported by 97.4% of women with severe symptoms. This finding is consistent with those of Amza et al. [22], who found that dysmenorrhea significantly reduces the health-related quality of life, particularly in physical and emotional functioning domains. Furthermore, 75.9% of women with severe dysmenorrhea reported missing 1 to 3 lectures because of pain, consistent with earlier studies reporting academic disruption due to menstrual pain [24, 33].

Several factors that influence the onset and severity of dysmenorrhea have been identified, including age at menarche, family history, lifestyle factors, and psychosomatic aspects. Our study corroborates the importance of a family history of dysmenorrhea, as participants in the severe group were more likely to report a familial predisposition [26, 34]. Psychosomatic factors, such as stress and pain tolerance, have also been linked to the severity of dysmenorrhea in other populations [35, 36].

Our study was conducted over an 18-month period from May 2023 to November 2024, spanning all four seasons. Seasonal variation in factors such as temperature, vitamin D exposure, mood, and physical activity may influence the severity of dysmenorrhea. For example, colder months may be associated with increased muscle tension or reduced physical activity, potentially exacerbating pain symptoms [37]. Because the timing of our data collection did not control for seasonality, this could represent a source of variability in symptom reporting. Future studies may benefit from examining seasonal trends more explicitly, or stratifying data collection accordingly to assess potential seasonal effects.

This study has several limitations that should be considered. The sample was drawn from a single academic institution, which limits the ability to generalize the findings to other regions or populations. In addition, the cross-sectional study design does not allow causal inferences to be drawn. Future research should include more diverse samples and employ longitudinal methodologies to build on these results and provide a better understanding of dysmenorrhea and its associated factors. The use of self-reported data may also have led to recall bias and social desirability bias. While self-reporting remains a practical and widely accepted method for assessing menstrual symptoms, responses may still be influenced by personal interpretation or hesitancy in disclosure. Finally, due to logistical constraints, convenience sampling was used for efficient recruitment within a defined academic setting. While this method facilitates access to a relevant population, it introduces potential selection bias and limits the generalizability of findings to broader populations. Participants who chose to respond may differ systematically from non-respondents in ways that affect their reporting of dysmenorrhea prevalence or severity.

Despite these limitations, our study has solid clinical applications. Healthcare providers in Saudi Arabia can use the findings of recent dysmenorrhea research to make practical, evidence-based improvements in care. One key step is to incorporate the WaLIDD score into routine practice. Providers should proactively and routinely screen women of reproductive age, particularly those with high risk factors such as elevated BMI, prior to the development of symptoms. WaLIDD scores can help in the early identification of women with significant pain and in whom intervention is warranted. Such screening is crucial in the Saudi context, where many women normalize menstrual pain and avoid seeking care. A high WaLIDD score in an at-risk patient should prompt personalized counseling on lifestyle modifications (weight management, exercise) to help reduce symptoms, as well as timely referrals. It can also be used to guide treatment adjustments for better pain management, such as optimizing the use of nonsteroidal anti-inflammatory drug (NSAID) or trialing hormonal therapies.

5. Conclusions

This study provides important insights into the prevalence and impact of dysmenorrhea among female university students in the Eastern region of Saudi Arabia. The findings indicate that severe dysmenorrhea is both common and significantly disruptive, affecting daily activities, academic attendance, and overall quality of life. Factors such as elevated BMI, irregular menstrual cycles, and heavier menstrual flow were significantly associated with an increased severity of dysmenorrhea, consistent with the findings of similar global studies.

These results underscore the need for improved management strategies and targeted interventions to support young women in managing their symptoms. Given the complex nature of dysmenorrhea, which includes both physical and psychological components, a multidisciplinary approach to treatment may be particularly beneficial.

Future research should aim to include more diverse populations and longitudinal study designs to better understand the long-term effects of dysmenorrhea and develop effective prevention strategies. This study helps fill a critical gap in the regional literature and emphasizes the need for greater awareness and support for women experiencing this condition.

Availability of Data and Materials

The data that support the findings of this study are available from the corresponding author, Zahraa Alali, upon reasonable request.

References

[1] Kirsch E, Rahman S, Kerolus K, Hasan R, Kowalska DB, Desai A, et al. Dysmenorrhea, a Narrative Review of Therapeutic Options. Journal of Pain Research. 2024; 17: 2657–2666. https://doi.org/10.2147/JPR.S459584.

[2] Dawood MY. Dysmenorrhea. The Journal of Reproductive Medicine. 1985; 30: 154–167.

[3] Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstetrics and Gynecology. 2006; 108: 428–441. https://doi.org/10.1097/01.AOG.0000230214.26638.0c.

[4] Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiologic Reviews. 2014; 36: 104–113. https://doi.org/10.1093/epirev/mxt009.

[5] Kural M, Noor NN, Pandit D, Joshi T, Patil A. Menstrual characteristics and prevalence of dysmenorrhea in college going girls. Journal of Family Medicine and Primary Care. 2015; 4: 426–431. https://doi.org/10.4103/2249-4863.161345.

[6] Vlachou E, Owens DA, Lavdaniti M, Kalemikerakis J, Evagelou E, Margari N, et al. Prevalence, Wellbeing, and Symptoms of Dysmenorrhea among University Nursing Students in Greece. Diseases (Basel, Switzerland). 2019; 7: 5. https://doi.org/10.3390/diseases7010005.

[7] Fernández-Martínez E, Onieva-Zafra MD, Parra-Fernández ML. Lifestyle and prevalence of dysmenorrhea among Spanish female university students. PloS One. 2018; 13: e0201894. https://doi.org/10.1371/journal.pone.0201894.

[8] Molla A, Duko B, Girma B, Madoro D, Nigussie J, Belayneh Z, et al. Prevalence of dysmenorrhea and associated factors among students in Ethiopia: A systematic review and meta-analysis. Women’s Health (London, England). 2022; 18: 17455057221079443. https://doi.org/10.1177/17455057221079443.

[9] Jareebi MA, Almraysi SA, Otayf DAH, Alneel GA, Zughaibi AH, Mobarki SJ, et al. Dysmenorrhea Among Women Living in Saudi Arabia: Prevalence, Determinants, and Impact. Life (Basel, Switzerland). 2025; 15: 108. https://doi.org/10.3390/life15010108.

[10] Bakhsh H, Algenaimi E, Aldhuwayhi R, AboWadaan M. Prevalence of dysmenorrhea among reproductive age group in Saudi Women. BMC Women’s Health. 2022; 22: 78. https://doi.org/10.1186/s12905-022-01654-9.

[11] Abdel-Salam DM, Alnuman RW, Alrwuaili RM, Alrwuaili GA, Alrwuaili EM. Epidemiological aspects of dysmenorrhea among female students at Jouf University, Saudi Arabia. Middle East Fertility Society Journal. 2018; 23: 435–439. https://doi.org/10.1016/j.mefs.2018.08.001.

[12] Alateeq D, Binsuwaidan L, Alazwari L, Algarni M, Al Hussain M, Alzahrani R, et al. Dysmenorrhea and depressive symptoms among female university students: a descriptive study from Saudi Arabia. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2022; 58: 106. https://doi.org/10.1186/s41983-022-00542-1.

[13] Alsaleem MA. Dysmenorrhea, associated symptoms, and management among students at King Khalid University, Saudi Arabia: An exploratory study. Journal of Family Medicine and Primary Care. 2018; 7: 769–774. https://doi.org/10.4103/jfmpc.jfmpc_113_18.

[14] Hashim RT, Alkhalifah SS, Alsalman AA, Alfaris DM, Alhussaini MA, Qasim RS, et al. Prevalence of primary dysmenorrhea and its effect on the quality of life amongst female medical students at King Saud University, Riyadh, Saudi Arabia. A cross-sectional study. Saudi Medical Journal. 2020; 41: 283–289. https://doi.org/10.15537/smj.2020.3.24988.

[15] Almanasef M, Alqarni H. Self-care strategies for the management of primary dysmenorrhea among young women in Asir region, Saudi Arabia: a cross-sectional study. European Review for Medical and Pharmacological Sciences. 2023; 27: 172–178. https://doi.org/10.26355/eurrev_202301_30869.

[16] Mizuta R, Maeda N, Tashiro T, Suzuki Y, Oda S, Komiya M, et al. Quality of life by dysmenorrhea severity in young and adult Japanese females: A web-based cross-sectional study. PloS One. 2023; 18: e0283130. https://doi.org/10.1371/journal.pone.0283130.

[17] Teherán AA, Piñeros LG, Pulido F, Mejía Guatibonza MC. WaLIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. International Journal of Women’s Health. 2018; 10: 35–45. https://doi.org/10.2147/IJWH.S143510.

[18] Takata K, Kotani K, Umino H. The Relationship Between Body Mass Index and Dysmenorrhea in the General Female Population. Journal of Clinical Medicine Research. 2023; 15: 239–242. https://doi.org/10.14740/jocmr4893.

[19] Ibrahim NK, AlGhamdi MS, Al-Shaibani AN, AlAmri FA, Alharbi HA, Al-Jadani AK, et al. Dysmenorrhea among female medical students in King Abdulaziz University: Prevalence, Predictors and outcome. Pakistan Journal of Medical Sciences. 2015; 31: 1312–1317. https://doi.org/10.12669/pjms.316.8752.

[20] Rafique N, Al-Sheikh MH. Prevalence of primary dysmenorrhea and its relationship with body mass index. The Journal of Obstetrics and Gynaecology Research. 2018; 44: 1773–1778. https://doi.org/10.1111/jog.13697.

[21] Rafique N, Al-Sheikh MH. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Medical Journal. 2018; 39: 67–73. https://doi.org/10.15537/smj.2018.1.21438.

[22] Amza M, Findeklee S, Haj Hamoud B, Sima RM, Poenaru MO, Popescu M, et al. Dysmenorrhea and Its Impact on Patients’ Quality of Life-A Cross-Sectional Study. Journal of Clinical Medicine. 2024; 13: 5660. https://doi.org/10.3390/jcm13195660.

[23] Ghandour R, Hammoudeh W, Stigum H, Giacaman R, Fjeld H, Holmboe-Ottesen G. The hidden burden of dysmenorrhea among adolescent girls in Palestine refugee camps: a focus on well-being and academic performance. BMC Public Health. 2024; 24: 726. https://doi.org/10.1186/s12889-024-18219-0.

[24] Unsal A, Ayranci U, Tozun M, Arslan G, Calik E. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences. 2010; 115: 138–145. https://doi.org/10.3109/03009730903457218.

[25] Mohapatra D, Mishra T, Behera M, Panda P. A study of relation between body mass index and dysmenorrhea and its impact on daily activities of medical students. Asian Journal of Pharmaceutical and Clinical Research. 2016; 9: 297–299. https://doi.org/10.22159/ajpcr.2016.v9s3.14753.

[26] Hu Z, Tang L, Chen L, Kaminga AC, Xu H. Prevalence and Risk Factors Associated with Primary Dysmenorrhea among Chinese Female University Students: A Cross-sectional Study. Journal of Pediatric and Adolescent Gynecology. 2020; 33: 15–22. https://doi.org/10.1016/j.jpag.2019.09.004.

[27] Tavallaee M, Joffres MR, Corber SJ, Bayanzadeh M, Rad MM. The prevalence of menstrual pain and associated risk factors among Iranian women. The Journal of Obstetrics and Gynaecology Research. 2011; 37: 442–451. https://doi.org/10.1111/j.1447-0756.2010.01362.x.

[28] Sánchez-López S, Barrington DJ, Poveda-Bautista R, Moll-López S. A mixed method study of menstrual health in Spain: pain, disorders, and the journey for health. Frontiers in Public Health. 2025; 13: 1517302. https://doi.org/10.3389/fpubh.2025.1517302.

[29] Francavilla R, Petraroli M, Messina G, Stanyevic B, Bellani AM, Esposito SM, et al. Dysmenorrhea: epidemiology, causes and current state of the art for treatment. Clinical and Experimental Obstetrics & Gynecology. 2023; 50: 274. https://doi.org/10.31083/j.ceog5012274.

[30] Muluneh AA, Nigussie TS, Gebreslasie KZ, Anteneh KT, Kassa ZY. Prevalence and associated factors of dysmenorrhea among secondary and preparatory school students in Debremarkos town, North-West Ethiopia. BMC Women’s Health. 2018; 18: 57. https://doi.org/10.1186/s12905-018-0552-x.

[31] Jang IA, Kim MY, Lee SR, Jeong KA, Chung HW. Factors related to dysmenorrhea among Vietnamese and Vietnamese marriage immigrant women in South Korea. Obstetrics & Gynecology Science. 2013; 56: 242–248. https://doi.org/10.5468/ogs.2013.56.4.242.

[32] Tatyana A, Taiwo O, Chinedu N, Ufuoma A. Dysmenorrhea and impact on Quality of Life. Journal of Current Medical Research and Opinion. 2017; 1. https://doi.org/10.15520/jcmro.v1i3.16.

[33] Kahal F, Alshayeb S, Torbey A, Al Helwani O, Kadri S, Helwani A, et al. The prevalence of menstrual disorders and their association with psychological stress in Syrian students enrolled at health-related schools: A cross-sectional study. International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2024; 164: 1086–1093. https://doi.org/10.1002/ijgo.15152.

[34] Gagua T, Tkeshelashvili B, Gagua D. Primary dysmenorrhea: prevalence in adolescent population of Tbilisi, Georgia and risk factors. Journal of the Turkish German Gynecological Association. 2012; 13: 162–168. https://doi.org/10.5152/jtgga.2012.21.

[35] Alleva E, Khalil S, Glazer K, Stone J, Viganò P, Somigliana E, et al. Risk of Ischemic Heart Disease in Women with Dysmenorrhea: A Longitudinal Analysis of 251,264 Patients Across Three Diverse Cohorts. medRxiv. 2024. https://doi.org/10.1101/2024.10.04.24314831. (preprint)

[36] Fatimah AD, Rohmah FN. The Relation Between Physical Activities and the Occurrence of Dysmenorrhea. Disease Prevention and Public Health Journal. 2020; 14: 76. https://doi.org/10.12928/dpphj.v14i2.2480.

[37] Wu T, Doyle C, Ito J, Ramesh N, Ernest DK, Crespo NC, et al. Cold Exposures in Relation to Dysmenorrhea among Asian and White Women. International Journal of Environmental Research and Public Health. 2023; 21: 56. https://doi.org/10.3390/ijerph21010056.

Funding

Deanship of Scientific Research at the University of Hafr Al Batin(0068-1443-S)