Archives of Women's Mental Health

, Volume 21, Issue 5, pp 533–541 | Cite as

Somatic symptoms in women with dysmenorrhea and noncyclic pelvic pain

  • Rebecca M. Zuckerman
  • Rebecca L. SiltonEmail author
  • Frank F. Tu
  • Joshua S. Eng
  • Kevin M. Hellman
Original Article


Somatic symptoms are a robust, transdiagnostic risk factor for pain conditions. However, the extent to which somatic symptoms contribute to the manifestation of the women’s pain syndromes, such as dysmenorrhea and noncyclic pelvic pain (NCPP), is unclear due to high rates of co-occurrence. Therefore, the present study investigated the primary hypothesis that somatic symptoms would be elevated in NCPP and distinctly influence the relationship between dysmenorrhea and co-occurring NCPP. A secondary analysis was performed on cross-sectional questionnaire data from 1012 nonpregnant reproductive-aged women. Eligible analyzed participants (n = 834) were categorized into four groups: healthy, dysmenorrhea, NCPP, and NCPP with co-occurring dysmenorrhea (NCPP+dysmenorrhea). A parallel mediation analysis was run to evaluate the primary hypothesis that somatic symptoms are the primary factor associated with increased NCPP accounting for dysmenorrhea. The NCPP+dysmenorrhea group had higher somatic, anxiety, and depression symptom T-scores (respectively 61, 61, 60) compared to the healthy controls (46, 51, 51; p’s < .001) and the dysmenorrhea group (50, 53, 54; p’s < .001). The pain and psychological symptoms were significantly correlated across the entire sample (r’s = .29, − .64, p’s < .01). Results from parallel mediation analysis showed that somatic symptoms were distinctly associated with NCPP+dysmenorrhea. Women with NCPP+dysmenorrhea have increased psychological and somatic symptoms compared to women with dysmenorrhea alone. Given that NCPP often co-occurs with dysmenorrhea, failure to account for comorbidity in previous studies has likely led to an overestimation of psychological symptoms in dysmenorrhea. Future studies should evaluate whether somatic sensitivity is a modifiable risk factor for NCPP.


Somatic symptoms Dysmenorrhea Noncyclic pelvic pain Comorbidity 



This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health  (NIH) under Award Number R21HD081709 (KH), by the National Institute Of Diabetes And DigestiveAnd Kidney Diseases of the NIH under Award Number R01DK100368 (FT), and NorthShore University Health System (FT). The authors thank Dr. Gerald Gebhart, Dr. Richard Silver, and Genevieve Roth for their constructive advice and editorial assistance.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Rebecca M. Zuckerman
    • 1
  • Rebecca L. Silton
    • 2
    Email author
  • Frank F. Tu
    • 1
    • 3
  • Joshua S. Eng
    • 4
  • Kevin M. Hellman
    • 1
    • 3
  1. 1.Pritzker School of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Department of PsychologyLoyola University ChicagoChicagoUSA
  3. 3.Department of Ob/GynNorthShore University HealthSystemEvanstonUSA
  4. 4.Department of Child and Family Health StudiesNorthShore University HealthSystemEvanstonUSA

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