Original scientific paper

Iva Rrugia¹ , Daniela Shukova Stojmanovska² , Seryozha Gontarev² , Georgi Georgiev²

https://doi.org/10.46733/PESH2514293r

Abstract

The gynecological condition primary dysmenorrhea creates operational problems for women aged 16 to 50 years old during their daily activities. The research examined how the Mediterranean diet impacts the occurrence and intensity of primary dysmenorrhea among women between 16 and 50 years old. The researchers conducted a cross-sectional study which collected data from 401 participants through an online survey that measured their menstrual symptoms and eating habits and body mass index (BMI). The survey results showed that primary dysmenorrhea symptoms affected 70.3% of all study participants. The study demonstrated that participants who scored high on the KIDMED index for Mediterranean diet assessment had a 63.7% chance of experiencing dysmenorrhea but those with low KIDMED scores showed an 80% occurrence rate. The research findings demonstrated a substantial link (p = 0.025) which proves that following the Mediterranean diet results in fewer cases of primary dysmenorrhea. The ANOVA results showed a significant difference between KIDMED index scores of participants who had dysmenorrhea and those who did not (F = 6.816, p = 0.009). The KIDMED index scores reached 5 points for women with dysmenorrhea while those without dysmenorrhea scored 6.65 points with 2.43 standard deviations and 2.59 standard deviations respectively. The research data showed that dysmenorrhea patients had an average BMI of 23.17 while non-dysmenorrhea patients had an average BMI of 23.73. The research data shows that the observed differences between groups fail to reach statistical significance. The research needs more longitudinal and experimental studies to establish the relationship between diet selection and body mass index with menstrual health and pain management.

Key words: Primary dysmenorrhea, Mediterranean diet, KIDMED index, BMI, Women’s health.

____________________________

References

Abid, F., Aamer, M., Faiz, S., Azam, F., Shaheen, A., & Javed, N. (2020). Dysmenorrhea in Students: Characteristics and Predictors. Journal of Shifa Tameer-E-Millat University, 3(2), 75–80. https://doi.org/10.32593/jstmu/vol3.iss2.96

Aktaş, D. (2023). The Relationships Between Primary Dysmenorrhea with Body Mass Index and Nutritional Habits in Young Women. Journal of Education and Research in Nursing, 143–149. https://doi.org/10.14744/jern.2021.93151

Armour, M., Ee, C. C., Naidoo, D., Ayati, Z., Chalmers, K. J., Steel, K. A., De Manincor, M. J., & Delshad, E. (2019). Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews, 2019(9). https://doi.org/10.1002/14651858.CD004142.pub4 Bajalan, Z., Alimoradi, Z., & Moafi, F. (2019). Nutrition as a Potential Factor of Primary Dysmenorrhea: A Systematic Review of

Observational Studies. Gynecologic and Obstetric Investigation, 84(3), 209–224. https://doi.org/10.1159/000495408 Barnard, N. D., Scialli, A. R., Hurlock, D., & Bertron, P. (2000). Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstetrics and gynecology, 95(2), 245–250. https://doi.org/10.1016/s0029-7844(99)00525-6

Bavil, D. A., Dolatian, M., Mahmoodi, Z., & Baghban, A. A. (2016). Comparison of Lifestyles of Young Women With and Without Primary Dysmenorrhea. Electronic Physician, 8(3), 2107–2114. https://doi.org/10.19082/2107

Brown, N., Martin, D., Waldron, M., Bruinvels, G., Farrant, L., & Fairchild, R. (2024). Nutritional practices to manage menstrual cycle related symptoms: A systematic review. Nutrition Research Reviews, 37(2), 352–375. https://doi.org/10.1017/S0954422423000227

Chakraborty, T. R., Donthireddy, L., Adhikary, D., & Chakraborty, S. (2016). Long-Term High Fat Diet Has a Profound Effect on Body Weight, Hormone Levels, and Estrous Cycle in Mice. Medical science monitor : international medical journal of experimental and clinical research, 22, 1601–1608. https://doi.org/10.12659/msm.897628

Chauhan, M., & Kala, J. (2012). Relation Between Dysmenorrhea and Body Mass Index in Adolescents with Rural Versus Urban Variation. The Journal of Obstetrics and Gynecology of India, 62(4), 442–445. https://doi.org/10.1007/s13224-012-0171-7

Chesney, M. A., & Tasto, D. L. (1975). The development of the menstrual symptom questionnaire. Behaviour Research and Therapy, 13(4), 237–244. https://doi.org/10.1016/0005-7967(75)90028-5

Ciołek, A., Kostecka, M., Kostecka, J., Kawecka, P., & Popik-Samborska, M. (2023). An Assessment of Women’s Knowledge of the Menstrual Cycle and the Influence of Diet and Adherence to Dietary Patterns on the Alleviation or Exacerbation of Menstrual Distress. Nutrients, 16(1), 69. https://doi.org/10.3390/nu16010069

Cirillo, M. (2023). Mediterranean Diet and Oxidative Stress: A Relationship With Pain Perception in Endometriosis. International Journal of Molecular Sciences, 24(19), 14601. https://doi.org/10.3390/ijms241914601

De Sanctis, V., Soliman, A., Bernasconi, S., Bianchin, L., Bona, G., Bozzola, M., Buzi, F., De Sanctis, C., Tonini, G., Rigon, F., & Perissinotto, E. (2015). Primary Dysmenorrhea in Adolescents: Prevalence, Impact and Recent Knowledge. Pediatric Endocrinology Reviews: PER, 13(2), 512–520.

Dehnavi, Z. M., Jafarnejad, F., & Kamali, Z. (2018). The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study. Journal of Education and Health Promotion, 7, 3. https://doi.org/10.4103/jehp.jehp_79_17

Deutch, B., Jørgensen, E. B., & Hansen, J. C. (2000). Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules). Nutrition Research, 20(5), 621–631. https://doi.org/10.1016/s0271-5317(00)00152-4

Donayeva, A., Amanzholkyzy, A., Nurgaliyeva, R., Gubasheva, G., Abdelazim, I. A., & Samaha, I. I. (2023). The relation between primary dysmenorrhea in adolescents and body mass index. Przeglad menopauzalny = Menopause review, 22(3), 126–129. https://doi.org/10.5114/pm.2023.131314

Dwivedi, D., Singh, N., & Gupta, U. (2024). Prevalence of Menstrual Disorder in Women and Its Correlation to Body Mass Index and Physical Activity. Journal of obstetrics and gynaecology of India, 74(1), 80–87. https://doi.org/10.1007/s13224-023-01914-0

Fang, X. (2023). Scientific Knowledge Graph of Dysmenorrhea: A Bibliometric Analysis From 2001 to 2021. Journal of Pain Research, Volume 16, 2883–2897. https://doi.org/10.2147/jpr.s418602

Franco-Antonio, C., Santano-Mogena, E., & Cordovilla-Guardia, S. (2025). Dysmenorrhea, premenstrual syndrome, and lifestyle habits in Young University students in Spain: A cross-sectional study. Journal of Nursing Research, 33(1). https://doi.org/10.1097/jnr.0000000000000657

Frisch R. E. (1987). Body fat, menarche, fitness and fertility. Human reproduction (Oxford, England), 2(6), 521–533. https://doi.org/10.1093/oxfordjournals.humrep.a136582

Frisch, R. E., & McArthur, J. W. (1974). Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science (New York, N.Y.), 185(4155), 949–951. https://doi.org/10.1126/science.185.4155.949 Güzeldere, H. K. B., Efendioğlu, E. H., Mutlu, S., Esen, H. N., Karaca, G. N., & Çağırdar, B. (2024). The relationship between

dietary habits and menstruation problems in women: a cross-sectional study. BMC women’s health, 24(1), 397. https://doi.org/10.1186/s12905-024-03235-4

Hadjou, O.-K., Jouannin, A., Lavoue, V., Leveque, J., Esvan, M., & Bidet, M. (2022). Prevalence of dysmenorrhea in adolescents in France: Results of a large cross-sectional study. Journal of Gynecology Obstetrics and Human Reproduction, 51(3), 102302. https://doi.org/10.1016/j.jogoh.2021.102302

Hajnasiri, H., Bahrami, N., Allen, K.-A., & Alimoradi, Z. (2022). Association of Body Mass Index and Dysmenorrhea: A Systematic Review and Meta-Analysis of Observational Studies. Current Womens Health Reviews, 18(3), e031121194769.

Hansen, S. O., & Knudsen, U. B. (2013). Endometriosis, dysmenorrhoea and Diet. European Journal of Obstetrics & Gynecology and Reproductive Biology, 169(2), 162–171. https://doi.org/10.1016/j.ejogrb.2013.03.028

Hu, Z., Tang, L., Chen, L., Kaminga, A. C., & Xu, H. (2020). Prevalence and Risk Factors Associated with Primary Dysmenorrhea among Chinese Female University Students: A Cross-sectional Study. Journal of Pediatric and Adolescent Gynecology, 33(1), 15–22. https://doi.org/10.1016/j.jpag.2019.09.004

Iacovides, S., Avidon, I., & Baker, F. C. (2015). What we know about primary dysmenorrhea today: A critical review. Human Reproduction Update, 21(6), 762–778. https://doi.org/10.1093/humupd/dmv039

Jahjaga A., Shukova Stojmanovska D., Gontarev S.,& Georgiev G. (2022). Correlation of mediterranean diet with some diseases. Journal of physical         education and sport, Vol. 22, issue 4, pages: 1051-1060. DOI: 10.7752/jpes.2022.04133.

Ibrahim, S. M., Aboushady, R. M. N., Kishk, D., & Abdeldaiem, N. A. (2021). Lifestyle Risk Factors and Occurrence of Primary Dysmenorrhea Among Adolescents: Suggested Guidelines. Egyptian Journal of Health Care, 12(2), 1844–1861. https://doi.org/10.21608/ejhc.2021.269547

Itani, R., Soubra, L., Karout, S., Rahme, D., Karout, L., & Khojah, H. M. J. (2022). Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean Journal of Family Medicine, 43(2), 101–108. https://doi.org/10.4082/kjfm.21.0103

Jahjaga, A., Shukova Stojmanovska, D., Gontarev, S.,&Georgiev G, G. (2022). Journal of Physical Education and Sport (JPES), Vol. 22 (issue 4), Art 133, pp. 1051 – 1060.

Jamali, T., Khalid, M., Shahid, T., Ghani, U., Baig, T., & Nasir, T. (2020). Severity and relation of primary dysmenorrhea and body mass index in undergraduate students of Karachi. A cross sectional survey. Journal of the Pakistan Medical Association, 0, 1. https://doi.org/10.5455/JPMA.18303

Ju, H., Jones, M., & Mishra, G. D. (2015). A U-Shaped Relationship between Body Mass Index and Dysmenorrhea: A Longitudinal Study. PLOS ONE, 10(7), e0134187. https://doi.org/10.1371/journal.pone.0134187

Khodakarami, B., Masoomi, S. Z., Faradmal, J., Nazari, M., Saadati, M., Sharifi, F., & shakhbabaei, M. (2015). The Severity of Dysmenorrhea and its Relationship with Body Mass Index among Female Adolescents in Hamadan, Iran. Journal of Midwifery and Reproductive Health, 3(4). https://doi.org/10.22038/jmrh.2015.4618

MacGregor, B., Allaire, C., Yong, P. J., & Bougie, O. (2023). Disease Burden of Dysmenorrhea: Impact on Life Course Potential.

International Journal of Women S Health, Volume 15, 499–509. https://doi.org/10.2147/ijwh.s380006

Moos, R. H. (1968). The Development of a Menstrual Distress Questionnaire: Psychosomatic Medicine, 30(6), 853–867. https://doi.org/10.1097/00006842-196811000-00006

Mucuk, S., Yılmaz, M., & Onur, A. (2022). Relationship between Dysmenorrhea, Dietary Inflammatory Index, and C-reactive Protein Level. Progress in Nutrition, 23(4), e2021156. https://doi.org/10.23751/pn.v23i4.11382

Najafi, N., Khalkhali, H., Moghaddam Tabrizi, F., & Zarrin, R. (2018). Major dietary patterns in relation to menstrual pain: A

nested case control study. BMC Women’s Health, 18(1), 69. https://doi.org/10.1186/s12905-018-0558-4

Omidvar, S., Bakouei, F., Amiri, F. N., & Begum, K. (2015). Primary Dysmenorrhea and Menstrual Symptoms in Indian Female Students: Prevalence, Impact and Management. Global Journal of Health Science, 8(8), 135. https://doi.org/10.5539/gjhs.v8n8p135

Onieva-Zafra, M. D., Fernández-Martínez, E., Abreu-Sánchez, A., Iglesias-López, M. T., Padilla, F. M. G., González, M. P., & Parra-Fernández, M. L. (2020). Relationship Between Diet, Menstrual Pain and Other Menstrual Characteristics Among Spanish Students. Nutrients, 12(6), 1759. https://doi.org/10.3390/nu12061759

Parra-Fernández, M. L., Onieva-Zafra, M. D., Abreu-Sánchez, A., Ramos-Pichardo, J. D., Iglesias-López, M. T., & Fernández-Martínez, E. (2020). Management of Primary Dysmenorrhea among University Students in the South of Spain and Family Influence. International Journal of Environmental Research and Public Health, 17(15), 5570. https://doi.org/10.3390/ijerph17155570

Samaha, I. (2023). The Impact of Primary Dysmenorrhea on Adolescents’ Activities and School Attendance. Journal of Medicine and Life, 16(10), 1462–1467. https://doi.org/10.25122/jml-2023-0247

Serra-Majem, L., Román-Viñas, B., Sanchez-Villegas, A., Guasch-Ferré, M., Corella, D., & La Vecchia, C. (2019). Benefits of the Mediterranean diet: Epidemiological and Molecular Aspects. Molecular Aspects of Medicine, 67, 1–55. https://doi.org/10.1016/j.mam.2019.06.001

Singh, M., Rajoura, O. P., & Honnakamble, R. A. (2019). Menstrual patterns and problems in association with body mass index among adolescent school girls. Journal of Family Medicine and Primary Care, 8(9), 2855–2858. https://doi.org/10.4103/jfmpc.jfmpc_474_19

Shukova Stojmanovska D., Aleksovska Velichkovska L., Gontarev S., Georgiev G., & Pluncevic Gligoroska J. (2023). Differences in the Mediterranean diet index, smoking and regular physical activity among students on university “ss. Cyril and Methodius”. Journal of Hygienic engineering and design, vol. 44. https://keypublishing.org/jhed/jhed-volumes/volume-44/

Torun, N. T., & Yildiz, Y. (2013). Assessment of Nutritional Status of 10 – 14 Years Old Adolescents Using Mediterranean Diet Quality Index (kidmed). Procedia – Social and Behavioral Sciences, 106, 512–518. https://doi.org/10.1016/j.sbspro.2013.12.057

Tuttolomondo, A., Simonetta, I., Daidone, M., Mogavero, A., Ortello, A., & Pinto, A. (2019). Metabolic and vascular effect of the Mediterranean Diet. International Journal of Molecular Sciences, 20(19), 4716. https://doi.org/10.3390/ijms20194716

Unsal, A., Ayranci, U., Tozun, M., Arslan, G., & Calik, E. (2010). Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences, 115(2), 138–145. https://doi.org/10.3109/03009730903457218

Veronese, N., Koyanagi, A., Stubbs, B., Cooper, C., Guglielmi, G., Rizzoli, R., Punzi, L., Rogoli, D., Caruso, M. G., Rotolo, O., Notarnicola, M., Al-Daghri, N., Smith, L., Reginster, J.-Y., & Maggi, S. (2019). Mediterranean diet and knee osteoarthritis outcomes: A longitudinal cohort study. Clinical Nutrition, 38(6), 2735–2739. https://doi.org/10.1016/j.clnu.2018.11.032

Wang, L., Yan, Y., Qiu, H., Xu, D., Zhu, J., Liu, J., & Li, H. (2022). Prevalence and Risk Factors of Primary Dysmenorrhea in Students: A Meta-Analysis. Value in Health, 25(10), 1678–1684. https://doi.org/10.1016/j.jval.2022.03.023

World Health Organization (2007). AnthroPlus. Retrieved August 15, 2020, from https://www.who.int/

Wu, L., Zhang, J., Tang, J., & Fang, H. (2022). The relation between body mass index and primary dysmenorrhea: A systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 101(12), 1364–1373. https://doi.org/10.1111/aogs.14449