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Dysmenorrhea, stress, and sleep quality in early adolescence: A systematic review

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Created On: 19/09/2026

Early adolescence represents a vulnerable window of neurobiological, hormonal, and circadian development.

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Key take away

High pain intensity and psychological stress independently and synergistically deteriorate sleep quality and circadian integrity in females with primary dysmenorrhea.

Background

Early adolescence represents a vulnerable window of neurobiological, hormonal, and circadian development. Primary dysmenorrhea (PD)—defined as painful lower abdominal cramping during menstruation in the absence of macrostructural pelvic pathology—is the leading gynecological complaint among junior high school girls.

Despite its high prevalence and systemic impact, PD is frequently underdiagnosed and undertreated. Beyond physical discomfort, PD interacts with psychological stress and neuroendocrine pathways, triggering profound sleep disruptions, social jetlag, and impaired academic and daily functioning in this adolescent cohort. This systematic literature review sought to determine the link between pain intensity and stress levels and sleep quality among PD-affected junior high school girls.

Method

The study was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 protocol. A systematic search across global medical databases identified studies exploring the interplay among pain intensity, psychological stress, and sleep parameters in adolescent females with PD.

Out of the identified literature, 10 studies met the strict inclusion and quality appraisal criteria, encompassing a total sample size of over 6,000 adolescent participants across diverse geographic regions, including Indonesia, South Korea, China, the United States, India, Turkey, and Brazil. Data were qualitatively synthesized to map out the physiological and psychological vectors affecting sleep outcomes.

Result

Pain intensity vs. sleep quality: A strong linear correlation was observed between menstrual pain severity and sleep disruption. High pain intensity, defined as a Numerical Rating Scale (NRS) score of 7 or higher, predicted overall poor sleep quality, characterized as a Pittsburgh Sleep Quality Index (PSQI) global score greater than 5.
Specific sleep impairments: Adolescents experiencing severe PD illustrated reduced total sleep duration, prolonged sleep onset latency, frequent sleep fragmentation, and compromised sleep efficiency.
Role of psychological stress: Psychological stress—assessed via validated clinical tools such as the Depression Anxiety Stress Scales-21 (DASS-21) and the Perceived Stress Scale (PSS)—acted as both an independent factor and a key mediator. Elevated stress levels directly amplified central pain perception and exacerbated sleep architecture degradation.
Circadian & developmental dynamics: Longitudinal data indicated that an earlier age at menarche compounded circadian rhythm vulnerabilities. Menstrual pain further aggravated existing circadian disruptions, including social jetlag, during the early adolescent transition.

Conclusion

PD is not merely a localized gynecological condition, but a multi-system disorder that interacts with psychological stress to hamper adolescent sleep quality and circadian stability. Effective management strategies within school health and pediatric clinical settings require a holistic approach that simultaneously targets pain relief, stress mitigation, and sleep hygiene interventions.

Source:

Eduvest-Journal of Universal Studies

Link:

https://eduvest.greenvest.co.id/index.php/edv/article/view/53099

Article:

The Relationship Between Pain Intensity and Stress Level on Sleep Quality Among Junior High School Girls with Primary Dysmenorrhea: A Systematic Literature Review