Antenatal indicators of postpartum depression: The role of menstrual pain history

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Created On: 04/07/2026

Postpartum depression (PPD) remains one of the most prevalent mental health complications following childbirth and can adversely affect maternal well-being, infant development, and family health.

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Key take away

A simple antenatal question about menstrual pain identifies women at increased risk of postpartum depressive symptoms.

Background

Postpartum depression (PPD) remains one of the most prevalent mental health complications following childbirth and can adversely affect maternal well-being, infant development, and family health. Early identification of women at heightened risk is a clinical priority; however, comprehensive screening for premenstrual mood disorders and menstrual health concerns is not always feasible in routine prenatal care.

Simple, scalable screening approaches may therefore improve risk stratification during pregnancy. Researchers evaluated whether a single yes-or-no question regarding menstrual pain could identify pregnant women at increased risk of developing postpartum depressive symptoms after delivery.

Method

A retrospective cohort study was executed at a tertiary perinatal care center. Menstrual pain history was routinely recorded during antenatal visits and categorized as a binary exposure (presence or absence of menstrual pain). The primary outcome was PPD symptoms, defined as an Edinburgh Postnatal Depression Scale (EPDS) score of 9 or higher at one month after childbirth.

Multivariable logistic regression analyses were performed to estimate adjusted odds ratios while controlling for maternal age, body mass index, infertility treatment, parity, multiple gestation, smoking during pregnancy, and prior mental health history. Sensitivity analyses using multiple imputation were also undertaken to assess the robustness of the findings.

Result

The analysis included 5,096 women and demonstrated a significant association between a history of menstrual pain and an increased risk of PPD at one month after childbirth. Women reporting menstrual pain showed a higher risk of PPD symptoms compared with those without menstrual pain (Table 1).

These findings supported the utility of a simple menstrual pain question as a potential indicator of elevated PPD risk, with affected women demonstrating a 39% higher adjusted likelihood of PPD symptoms (adjusted odds ratio 1.39; 95% confidence interval: 1.09–1.77), a 30% higher adjusted risk (risk ratio 1.3), and an absolute risk increase of 1.7 percentage points.

Conclusion

These results indicated that a routinely documented history of menstrual pain could help identify pregnant women who may be more susceptible to PPD symptoms. Incorporating this easily obtainable information into standard prenatal care may improve risk prediction, strengthen early intervention pathways, and contribute to better maternal mental health outcomes after childbirth.