723: Ecological study of pain, mood, and health outcomes in women with and without natural menstruation

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Non -specific to any diagnosis, Gender/sex differences, Assessment and Measurement of Pain/Nociception, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: The menstrual cycle is associated with changes in mood, sleep, and pain. Menstrual pain has a prevalence of 71.1% and has a substantial impact on disability and public health. Yet we have limited knowledge about the dynamics of how pain, health outcomes, and behavior change throughout the menstrual cycle, and how these are related to hormonal fluctuations. Here we used ecologically momentary assessment (EMA) to assess daily changes in various parameters throughout a full menstrual cycle. We compared women with natural menstruation (NM group) with women using combined hormonal oral contraceptives (CC group).

Methods: We recruited 67 healthy women (NM: n=36, mean±SD age: 27.73±6.26, range 19–40; CC: n=31, age: 28.29±6.99, range 20–44), who completed questionnaires (mood, sleep, pain, premenstrual/menstrual symptoms) twice a day during a full menstrual cycle. Each participant completed two study visits (NM participants: mid follicular vs. mid luteal phase; CC users: pill vs. pill free intervals; Continuous CC users: two days with corresponding interval). Study visits included quantitative sensory testing, resting heart rate variability, experimental assessement of threat sensitivity, and saliva samples for hormonal analysis of estradiol and progesterone. The study was preregistered at OSF.

Results: Daily symptom levels did not differ overall between NM and CC. However, NM participants showed significantly greater within-person variability in menstrual symptoms, including irritability (p=0.036), cramps (p=0.014), and breast tenderness (p=0.007). In NM, pain intensity differed between menstrual cycle phases (F(2,24)=10.74, p<0.001); posthoc comparisons revealed higher pain during the menstrual phase than post-menstrual follicular and luteal phases. Evoked heat pain intensity did not differ between groups, but in NM, both perceived and expected pain of high-pain stimuli (individually calibrated) were higher during mid-follicular phase (visit 1) than mid-luteal phase (visit 2; pain: t=2.35, p=0.026; expectancy: t=2.45, p=0.020).

Conclusions: We found that women with a natural menstruation cycle, compared to those using hormonal contraception had increased variability in a variety of menstual symptoms, although the mean symptom levels were not different between groups. Moreover, for the NM group, we found differences between menstrual phases in both daily pain intensity and to perceived and expected experimental pain stimuli. These results add to our understanding of menstrual cycle–related symptoms and the role of sex hormones in pain, and highlighs potential differences between women with and without a natural menstrual cycle.

References: 1. Harel, Z. Dysmenorrhea in adolescents and young adults: from pathophysiology to pharmacological treatments and management strategies. Expert Opin. Pharmacother. 9, 2661–2672 (2008).
2. MacGregor, B., Allaire, C., Bedaiwy, M. A., Yong, P. J. & Bougie, O. Disease Burden of Dysmenorrhea: Impact on Life Course Potential. Int. J. Womens Health 15, 499 (2023).
3. Armour, M. et al. The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis. J. Womens Health 28, 1161–1171 (2019).
4. Lee, S., Dan-Mikael Ellingsen & Hjelmervik, H. An ecologically valid study of pain, mood and other health outcomes of women with and without a natural menstruation during the menstrual cycle. Preprint at https://doi.org/10.17605/OSF.IO/9U7QE (2025).

Presenting Author: Seoyoung Lee
Submitting Author: Seoyoung Lee

Senior Author: Dan-Mikael Ellingsen

IASP 2026 Global Year theme of Neuropathic Pain: No

• Adrian Nicolaisen Tiseth: MSc - Oslo University Hospital
• Helene Hjelmervik: PhD - School of health sciences, Kristiania University College
• Dan-Mikael Ellingsen: PhD - School of health sciences, Kristiania University College