---
title: What factors increase risk of period pain and PMS symptoms? | Niyora
description: Stress, poor sleep, late bedtimes, low weight, and family history increase risk. Smoking makes symptoms more severe. Most of these factors can be modified thr
url: https://niyora.com/research/papers/factors-associated-with-the-prevalence-and-severity-of-menstrual-related-2022/
---

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- What factors increase risk of period pain and PMS symptoms?

Systematic review, 2022

# What factors increase risk of period pain and PMS symptoms?

Stress, poor sleep, late bedtimes, low weight, and family history increase risk. Smoking makes symptoms more severe. Most of these factors can be modified through lifestyle changes.

 Strong study design

Women with period pain or PMS across 77 studies

## What they did

Meta-analysis of 77 studies examining factors linked to period pain and PMS. Researchers assessed study quality using a standardized checklist.

## What they found

Eight factors increased period pain risk: age 20 or older (odds ratio 1.18), BMI under 18.5 (odds ratio 1.51), irregular menstrual cycle (odds ratio 1.28), family history of period pain (odds ratio 3.80), stress (odds ratio 1.88), sleeping less than 7 hours (odds ratio 1.19), and bedtime after 23:01 (odds ratio 1.30). Longer menstrual periods were protective (odds ratio 0.16). For severe pain: low BMI (odds ratio 1.89) and smoking (odds ratio 1.94) increased severity.

## What it means for you

Many risk factors are things women can change such as managing stress, sleeping more, and going to bed earlier. Family history cannot be changed but knowing it is a risk factor helps inform expectations. This is based on large combined analysis so findings are fairly reliable.

77

studies included in meta-analysis

3.80

family history odds ratio for period pain

1.88

stress odds ratio for period pain

## About the study

Original title Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis Authors Mitsuhashi R, Sawai A, Kiyohara K et al. Journal International journal of environmental research and public health Year 2022 Study design Systematic review What was tested None (observational study of risk factors) Open access Yes Read the paper [doi.org/10.3390/ijerph20010569](https://doi.org/10.3390/ijerph20010569) Original abstract

This study aimed to identify factors associated with the prevalence and severity of menstrual-related symptoms. The protocol was registered in PROSPERO (CRD42021208432). We conducted literature searches of PubMed and Ichushi-Web and used the Jonna Briggs Institute critical appraisal checklist to assess the quality. Of the 77 studies included in the meta-analysis, significant odds ratios (ORs) were obtained for eight factors associated with primary dysmenorrhea (PD): age ≥ 20 years (OR: 1.18; 95% confidence interval [CI]: 1.04−1.34), body mass index (BMI) < 18.5 kg/m2 (OR: 1.51; 95% CI: 1.01−2.26), longer menstrual periods (OR: 0.16; 95% CI: 0.04−0.28), irregular menstrual cycle (OR: 1.28; 95% CI: 1.13−1.45), family history of PD (OR: 3.80; 95% CI: 2.18−6.61), stress (OR: 1.88; 95% CI: 1.30−2.72), sleeping hours < 7 h (OR: 1.19; 95% CI: 1.04−1.35), and bedtime after 23:01 (OR: 1.30; 95% CI: 1.16−1.45). Two factors were associated with severity of PD (moderate vs. severe): BMI < 18.5 kg/m2 (OR: 1.89; 95% CI: 1.01−3.54) and smoking (OR: 1.94; 95% CI: 1.08−3.47). PD severity (mild vs. severe) and prevalence of premenstrual syndrome were associated with BMI < 18.5 kg/m2 (OR: 1.91; 95% CI: 1.04−3.50) and smoking (OR: 1.86; 95% CI: 1.31−2.66), respectively. The identified risk factors could be utilized to construct an appropriate strategy to improve menstrual symptoms and support women’s health.

Reproduced under CC-BY.

## Topics

[Premenstrual syndrome (PMS)](https://niyora.com/research/topics/condition-pms/)[Dysmenorrhea and period pain](https://niyora.com/research/topics/condition-dysmenorrhea/)[Alcohol, smoking and substance use](https://niyora.com/research/topics/comorbidity-substance-use/)

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