Abstract 1, non-pharmacologic treatments
Dysmenorrhea in Adolescent and Young Adult Females with Inflammatory Bowel Disease: Characteristics and Perceived Nonpharmacologic Treatment Effectiveness
1University of North Carolina at Chapel Hill, 2University of Pittsburgh Medical Center, 3Nationwide Children’s Hospital, 4Icahn School of Medicine at Mount Sinai
Background
Dysmenorrhea, or painful menstruation, can impair functioning for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD). Safety concerns about non-steroidal anti-inflammatory drugs and combined oral contraceptives in IBD (gold-standard dysmenorrhea treatments) are widely cited despite limited evidence and may lead AYAs with IBD to rely on non-pharmacologic strategies. Yet, little is known about which lifestyle treatments they use or find effective. We assessed menstrual symptoms and perceived effectiveness of non-pharmacologic dysmenorrhea treatments among AYAs with IBD.
Methods
We conducted a cross-sectional study of AYAs with IBD (age 14-25 years) assigned female at birth at academic tertiary-care centers in New York (NY), North Carolina (NC), Pennsylvania (PA), and Ohio (OH). Participants, recruited in IBD clinic or via REDCap or patient portal messages, completed an electronic survey on their demographics, IBD history, and menstrual symptoms/treatments. Symptom severity was rated on a 3-point scale and treatment effectiveness on a 5-point scale. We used descriptive statistics overall and stratified by dysmenorrhea severity (mild vs. moderate-to-severe), with t-tests and chi-square for bivariate comparisons.
Results
Of 367 participants, 248 (68%) reported dysmenorrhea in the past six months (Age: 20.4 ± 3.2 years; 61% Crohn’s disease; 80% White; 6% Hispanic; 48% NC, 16% NY, 16% PA, 15% OH). Most (67% overall; 69% with dysmenorrhea) perceived IBD symptom worsening during menses, especially abdominal pain, bloating, and diarrhea. Almost all (96%) who endorsed perimenstrual IBD symptom worsening also reported dysmenorrhea. Of those with dysmenorrhea, 92% reported moderate-to-severe cramps, 75% had symptoms during most/all periods, and 64% reported moderate-to-severe functional impairment. Moderate-to-severe dysmenorrhea (vs. mild) was associated with moderate-to-severe IBD (24% vs. 0%, p<0.001). Over 70% of AYAs with dysmenorrhea also had perimenstrual diarrhea, fatigue, mood swings, and irritability, respectively. Of the 246 AYAs with dysmenorrhea who completed questions about treatments, 87% used pharmacologic and non-pharmacologic treatments, 7% used only non-pharmacologic treatments, and none used no treatments. The most common non-pharmacologic treatments were rest (86%) and topical heat application (75%; Table). Perceived non-pharmacologic treatment effectiveness was highest for topical heat application and rest (Figure).
Conclusions
In a multi-site sample of AYAs with IBD, most respondents reported worsening of IBD symptoms during menses, suggesting menstrual health should be integrated into IBD care. Moderate-to-severe dysmenorrhea with functional impairment occurred commonly, often accompanied by diarrhea and mood changes. Topical heat and rest were rated as effective and widely used. Menstruating AYAs with IBD may experience a high symptom burden during their menstrual cycles, often treated with rest and topical heat application along with medications.
Show table: demographics, IBD history, and menstrual history, stratified by dysmenorrhea severity
| Characteristics | Total cohort reporting dysmenorrhea (N=248) | Mild dysmenorrhea (N=20) | Moderate to severe dysmenorrhea (N=228) | p value** | |||
|---|---|---|---|---|---|---|---|
| Demographics & IBD history | |||||||
| Age (years, mean, SD) | 20.4 | 3.2 | 19.4 | 3.2 | 20.5 | 3.2 | 0.136 |
| Crohn’s (vs. UC/IBD unclassified; n, %) | 151 | 61% | 14 | 70% | 137 | 61% | 0.384 |
| Overall IBD severity (n, %) | <0.001 | ||||||
| In remission | 87 | 35% | 8 | 40% | 79 | 35% | |
| Mild | 100 | 41% | 12 | 60% | 88 | 39% | |
| Moderate | 44 | 18% | 0 | 0% | 44 | 19% | |
| Severe | 12 | 5% | 0 | 0% | 12 | 5% | |
| Menstrual history | |||||||
| Bleeding duration (days; mean, SD) | 2.6 | 0.9 | 2.8 | 1.3 | 2.6 | 0.9 | 0.994 |
| Regular periods (n, %) | 165 | 67% | 12 | 60% | 153 | 68% | 0.518 |
| Blood flow (n, %) | 0.005 | ||||||
| Light | 36 | 15% | 5 | 25% | 31 | 14% | |
| Moderate | 112 | 45% | 9 | 45% | 103 | 45% | |
| Heavy | 79 | 32% | 4 | 20% | 75 | 33% | |
| Variable | 21 | 8% | 2 | 10% | 19 | 8% | |
| Other symptoms (n, %) | |||||||
| Heavy bleeding | 146 | 59% | 9 | 45% | 137 | 60% | 0.189 |
| Diarrhea | 179 | 72% | 12 | 60% | 167 | 73% | 0.205 |
| Nausea | 137 | 55% | 6 | 30% | 131 | 58% | 0.018 |
| Vomiting | 33 | 13% | 0 | 0% | 33 | 15% | 0.085 |
| Fatigue | 182 | 73% | 8 | 40% | 174 | 76% | <0.001 |
| Mood swings | 190 | 77% | 11 | 55% | 179 | 79% | 0.026 |
| Irritability | 192 | 77% | 8 | 40% | 184 | 81% | <0.001 |
| Perceived IBD symptoms (n, %) | |||||||
| GI bleeding | 15 | 6% | 0 | 0% | 15 | 7% | 0.618 |
| Nocturnal stools | 18 | 7% | 1 | 5% | 17 | 8% | 1.000 |
| Abdominal pain | 141 | 57% | 3 | 15% | 138 | 61% | <0.001 |
| Weight loss | 11 | 4% | 0 | 0% | 11 | 5% | 0.608 |
| Diarrhea | 120 | 48% | 4 | 20% | 116 | 51% | 0.008 |
| Frequent stools | 113 | 46% | 5 | 25% | 108 | 47% | 0.054 |
| Bloating | 134 | 54% | 7 | 35% | 127 | 56% | 0.075 |
| Nausea/vomiting | 72 | 29% | 3 | 15% | 69 | 30% | 0.149 |
| Loss of appetite | 70 | 28% | 0 | 0% | 70 | 31% | 0.003 |
| Fistula irritation | 13 | 5% | 0 | 0% | 13 | 6% | 0.608 |
| Dysmenorrhea functional impact (n, %) | <0.001 | ||||||
| None | 19 | 8% | 10 | 50% | 9 | 4% | |
| Mild | 68 | 28% | 9 | 45% | 59 | 27% | |
| Moderate | 89 | 37% | 1 | 5% | 88 | 40% | |
| Severe | 65 | 27% | 0 | 0% | 65 | 29% | |
| Dysmenorrhea frequency (n, %) | <0.001 | ||||||
| All/most menses | 184 | 74% | 5 | 25% | 179 | 79% | |
| Every 2-3 months | 41 | 17% | 7 | 35% | 34 | 15% | |
| Every 4-6 months | 21 | 8% | 8 | 40% | 13 | 6% | |
| Treatments (n, %) | |||||||
| Massage | 53 | 21% | 2 | 10% | 51 | 22% | 0.262 |
| Yoga | 38 | 15% | 3 | 15% | 35 | 15% | 1.000 |
| Exercise | 100 | 40% | 8 | 40% | 92 | 40% | 0.976 |
| Rest | 213 | 86% | 17 | 85% | 196 | 86% | 1.000 |
| Distraction | 139 | 56% | 8 | 40% | 131 | 58% | 0.132 |
| Topical heat application | 187 | 75% | 9 | 45% | 178 | 78% | 0.002 |
| Behavioral counseling | 11 | 4% | 0 | 0% | 11 | 5% | 0.608 |
| Acupressure/acupuncture | 5 | 2% | 1 | 5% | 4 | 2% | 0.346 |
| Dietary changes | 49 | 20% | 1 | 5% | 48 | 21% | 0.138 |
| Increase water intake | 137 | 55% | 9 | 45% | 128 | 56% | 0.337 |
| Drink herbal tea | 66 | 27% | 6 | 30% | 60 | 26% | 0.721 |
| None | 6 | 2% | 1 | 5% | 5 | 2% | 0.399 |
*Categories may not add up to 100% due to missing data and/or non-mutually exclusive categories. Categories with <5% of respondents, including % missing, were omitted unless clinically relevant. **P ≤0.05 considered statistically significant IBD = Inflammatory Bowel Disease; SD = standard deviation; UC = ulcerative colitis