Dysmenorrhea in women with Crohn's disease: A case-control study

Background: Dysmenorrhea and Crohn's disease (CD) have overlapping symptoms; however, their relationship is poorly understood. The aims of this study were to examine (1) the impact of dysmenorrhea on pain severity and pain medication use in CD and (2) the relationships between dysmenorrhea, CD activity, and health-related quality of life (HRQOL). Methods: This was a case-control study of menstruating women with and without CD. Subjects were assessed for dysmenorrhea, pain severity, medication use, menstrual distress, and HRQOL. CD activity scores were calculated. The correlation between menstrual distress and CD activity was assessed. Linear regression analysis was performed to determine the effects of dysmenorrhea and CD on pain severity. Results: A total of 110 subjects were studied and 40% of cases had dysmenorrhea. Dysmenorrhea was associated with higher pain scores among cases. Compared with controls, cases with dysmenorrhea reported similar pain severity but lower nonsteroidal anti-inflammatory drug use. After adjusting for medication use, cases had significantly greater distress due to menstrual pain. CD activity scores were not higher in women with dysmenorrhea; however, menstrual distress scores correlated positively with disease activity. HRQOL was significantly lower in cases with dysmenorrhea by some measures. Conclusions: Dysmenorrhea is common in women with CD and has an additive effect on overall pain severity. It is not, however, associated with greater nonsteroidal anti-inflammatory drug use. Menstrual distress is positively correlated with CD activity scores and associated with lower HRQOL by some measures. Treatment of dysmenorrhea may improve the pain experienced by women with CD, the perception of CD activity, and the quality of life in women with CD.