Back to Journals » International Journal of Women's Health » Volume 16

The Association of Reproductive Hormones During the Menstrual Period with Primary Dysmenorrhea [Letter]

Authors Erega BB , Ferede WY 

Received 23 December 2023

Accepted for publication 22 January 2024

Published 26 January 2024 Volume 2024:16 Pages 153—154


Checked for plagiarism Yes

Editor who approved publication: Professor Elie Al-Chaer

Besfat Berihun Erega, Wassie Yazie Ferede

Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia

Correspondence: Besfat Berihun Erega, Email [email protected]

View the original paper by Mrs Jiang and colleagues

Dear editor

With great pleasure, we have read a paper by Jiang et al, a case-control study among patients with dysmenorrhea and without dysmenorrhea, regarding the association of reproductive hormones during the menstrual period with primary dysmenorrhea. The study described the relationship of four reproductive hormones with the development of primary dysmenorrhea. The hormones included in the investigation were oxytocin, PGF2α, vasopressin, estriol, and estradiol collected three to five days after menstruation.1

Although the study aimed to access the pure association of reproductive hormones with primary dysmenorrhea, a research question arises here is whether the symptoms themselves for primary dysmenorrhea can differ with other clinically known risk factors like being below 20 years of age, history of dysmenorrhea in primary family members, early menarche, history of menorrhagia and nulliparity, low or high body mass index (BMI<18.5 and BMI>25), low omega 3 intake, tobacco and alcohol use, excessive caffeine consumption, and emotional problems such as stress, anxiety, and depression.1–4

We appreciated the authors in the way that they selected the case and control groups, the timing of serum sample collection, the scientific measurement of hormonal levels, and the statistical analysis that followed. But a second question raised here is that the authors included clients after three to four days of their monthly menstrual period in which most of the primary dysmenorrhea is expected to be relieved. Hence most of the symptoms of dysmenorrhea typically occur premenstrually and will subside after the menstrual phase or bleeding phase of the monthly cycle, otherwise we have to suspect anatomical disorders other than the physiological.5–7 This implied that the authors' inclusion term “spasmodic pain or similar to labor pain” could not be valid in this instance.

The authors mentioned the possible associated factors in a descriptive manner, but confusion still exists on the subjective nature of patient-rated spasmodic pain and the sophisticated interdependence of menstrual hormones with the lifestyle of a woman, other non-reproductive biomarkers.8 A study with a menstrual pain measuring or rating tool and determinants of these physiological hormones will be needed to clear these research questions.

We appreciate the authors for the detailed investigation of these reproductive hormones in studying its association with primary dysmenorrhea.


The authors report no conflicts of interest in this communication.


1. Jiang J, Zhuang Y, Si S, et al. The association of reproductive hormones during the menstrual period with primary dysmenorrhea. Int J Women’s Health. 2023;Volume 15:1501–1514. doi:10.2147/IJWH.S421950

2. Fernández-Martínez E, Onieva-Zafra MD, Parra-Fernández ML, Palazón-Bru A. Lifestyle and prevalence of dysmenorrhea among Spanish female university students. PLoS One. 2018;13(8):e0201894. doi:10.1371/journal.pone.0201894

3. Türkmen H. Frequency of dysmenorrhea in university students and factors affecting dysmenorrhea. [Üniversite öğrencilerinde dismenore görülme sıklığı ve dismenoreye etki eden faktörler]. Celal Bayar Üniversitesi Saglik Bilimleri Enstitüsü Dergisi [Celal Bayar University Health Sciences Institute Journal]. 2019;6(1):39–46.

4. Orhan C, Çelenay ŞT, Demirtürk F, et al. Effects of menstrual pain on the academic performance and participation in sports and social activities in Turkish university students with primary dysmenorrhea: a case control study. J Obstetrics Gynaecol Res. 2018;44(11):2101–2109. doi:10.1111/jog.13768

5. Eshetu N, Abebe H, Fikadu E, et al. Premenstrual syndrome, coping mechanisms and associated factors among Wolkite university female regular students, Ethiopia, 2021. BMC Women’s Health. 2022;22(1):88. doi:10.1186/s12905-022-01658-5

6. Yoshimi K, Shiina M, Takeda T. Lifestyle factors associated with premenstrual syndrome: a cross-sectional study of Japanese high school students. J Pediatr Adolesc Gynecol. 2019;32(6):590–595. doi:10.1016/j.jpag.2019.09.001

7. Boyacioğlu NE, Gökdemir F, Özcan NK. Investigation of factors related to menstrual and premenstrual symptoms. Arch Health Sci Res. 2021;8(1):46–55.

8. Paslay EM. Factors affecting luteal oxytocin synthesis and/or secretion by the ovine and bovine corpus luteum; 2002.

Creative Commons License © 2024 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.