Primary dysmenorrhea: Severe menstrual pain is associated with lower cognitive and daily functioning

New research published in the European Journal of Obstetrics & Gynecology and Reproductive Biology suggests that severe menstrual pain impacts much more than physical comfort. The findings provide evidence that women experiencing painful periods also face challenges with attention, thinking speed, self-esteem, and their ability to perform daily tasks. This research indicates that menstrual pain shapes how people function in their everyday lives, including at school or work.

Primary dysmenorrhea is a medical term for severe, recurring menstrual cramps that are not caused by an underlying disease or pelvic abnormality. The condition is extremely common among young women. It frequently causes lower abdominal pain that radiates to the thighs and peaks during the first two days of menstruation.

Scientists believe this intense discomfort is driven by an overproduction of prostaglandins. These are hormone-like chemicals that trigger strong uterine contractions. High levels of these chemicals can cause additional symptoms like nausea and fatigue alongside the primary abdominal pain.

Scientists noted that existing research on this topic tends to be highly fragmented. Past studies usually focused on single aspects of menstrual pain, such as the severity of the cramps or the psychological distress it causes. Few scientific efforts had evaluated how physical pain, mental skills, and emotional well-being interact over the course of a full menstrual cycle.

The researchers wanted to fill this gap by tracking these different factors together across distinct biological phases. They aimed to understand how variations in the menstrual cycle affect occupational performance. In occupational therapy, occupational performance refers to a person’s ability and satisfaction in carrying out meaningful daily roles, like studying, working, or socializing.

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“Many young women say things like ‘I just can’t focus,’ or ‘I don’t feel like myself’ during certain days of their cycle especially when they have menstrual pain,” said study author Gokcen Akyurek, an associate professor at Hacettepe University. “Despite how common this is, these experiences are often minimized or seen as ‘just part of being a woman.’ We wanted to understand whether these changes are real, measurable, and how they affect everyday life not just physically, but cognitively and emotionally.”

To examine these factors, the scientists recruited 138 young women between the ages of 17 and 25 years. The sample included 79 women who experienced primary dysmenorrhea and 59 asymptomatic women who did not experience menstrual pain. Physicians evaluated the participants to ensure their pain was not caused by secondary issues like endometriosis.

The researchers evaluated the participants at three distinct points in their menstrual cycles. These points included the first three days of bleeding, the mid-follicular phase roughly a week after menstruation begins, and the mid-luteal phase about a week before the next period starts.

During each session, participants completed several standardized questionnaires. These surveys measured pain intensity, body awareness, self-esteem, and attitudes toward menstruation. Participants also rated their own occupational performance and satisfaction to gauge how well they felt they were managing their daily routines.

In addition to the surveys, the researchers administered cognitive tests to measure mental sharpness. They used a well-known psychological assessment that measures selective attention and the ability to control impulsive responses. This test requires participants to look at color words printed in conflicting ink colors and correctly name the ink color rather than read the written word.

They also used an auditory addition task to evaluate how fast participants could process new information. In this test, participants listen to a series of numbers and must quickly add each new number to the one they heard just before it. This measures working memory, which is the brain’s ability to hold and manipulate information over short periods.

The results showed consistent differences between the two groups of women. Those with severe menstrual pain reported a lower body mass index, which is a measure of body fat based on height and weight. Researchers note that having adequate body fat is essential for hormonal regulation, and imbalances can increase the chemicals responsible for menstrual pain.

Women in the pain group also expressed more negative beliefs about menstruation, often viewing it as a debilitating event. They demonstrated lower self-esteem compared to the women without menstrual pain. This reduction in self-esteem and daily functioning was present across all phases of the menstrual cycle, not just during bleeding.

This persistent decline suggests that the psychological and functional toll of severe menstrual cramps extends beyond the days of actual physical pain. Mental performance also fluctuated depending on the timing of the menstrual cycle. For women with primary dysmenorrhea, attention and information processing speed declined significantly during the luteal phase.

The luteal phase occurs just before menstruation and involves significant hormonal changes, such as elevated progesterone. These hormonal shifts might interact with the anticipation of pain to cause temporary cognitive fatigue. By contrast, the women without menstrual pain did not experience these same mental declines.

Both groups reported that their occupational performance and body awareness hit their lowest points during the actual days of menstruation. Body awareness is the ability to recognize and understand internal physical sensations. When women experience high pain, they might detach from their bodily signals as a coping mechanism.

The women with severe cramps consistently rated their ability to manage daily life much lower than the asymptomatic women did. Statistical analysis showed that menstrual pain and negative attitudes were strong predictors of lowered self-esteem and reduced functionality. These findings highlight that primary dysmenorrhea creates a complex web of physical and emotional challenges.

“What surprised us most was how consistent and widespread the impact was,” Akyurek told PsyPost. “Women with menstrual pain didn’t just report feeling worse; they actually performed worse on cognitive tasks and reported lower confidence and daily functioning, especially during certain phases of the cycle.”

“Our findings show that it can affect attention, thinking speed, confidence, and even how well someone performs daily tasks like studying or working. In other words, it’s not just discomfort it can shape how people function in their daily lives.”

While this research provides a broad view of menstrual health, it does have some limitations to keep in mind. The study relied on participants self-reporting their menstrual phases rather than using blood tests to verify exact hormone levels. The scientists also did not control for outside factors like sleep quality, nutrition, or physical activity, which can all influence pain and mental sharpness.

The participants were largely university students, meaning the results might not fully apply to women in different age groups or educational backgrounds. Because the study compared groups at specific points in time, it cannot definitively prove that menstrual cramps directly cause these cognitive and emotional changes. Other unmeasured factors, such as underlying anxiety or stress, might play a role in how pain is experienced.

Future research will likely explore practical strategies to help individuals manage these symptoms. The scientists hope to develop targeted interventions that assist young women with painful periods.

“Our next goal is to move beyond understanding the problem and start developing solutions, especially practical strategies to help individuals manage these challenges in daily life, school, and work,” Akyurek said.

“One important message is that these experiences are real and measurable. When we start to recognize menstrual health as something that affects daily functioning “not just pain” we can create more supportive environments in education, workplaces, and healthcare.”

The study, “Neurocognitive function, psychosocial characteristics, and occupational performance across menstrual phases in young adults with and without primary dysmenorrhea,” was authored by Aysenur Karakus, Semanur Inanc, and Gokcen Akyurek.